HFpEF 患者 N 末端 B 型利钠肽、焦虑与社会支持的纵向关联：多中心随机对照 Aldo-DHF 试验结果。
Longitudinal association between N-terminal B-type natriuretic peptide, anxiety and social support in patients with HFpEF: results from the multicentre randomized controlled Aldo-DHF trial.
机构信息
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
Department of Cardiology, University Hospital Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany.
出版信息
BMC Cardiovasc Disord. 2023 Apr 5;23(1):184. doi: 10.1186/s12872-023-03136-8.
BACKGROUND
Higher plasma levels of natriuretic peptides (NPs) have been associated with reduced anxiety in experimental research and a number of patient samples. As NP levels are elevated in heart failure patients, we investigate whether this elevation is related to anxiety in patients with heart failure with preserved ejection fraction (HFpEF).
METHODS
Post-hoc regression and mediation analyses were conducted, using data of 422 patients with HFpEF from the randomized, placebo-controlled, double-blinded, two-armed, multicentre aldosterone in diastolic heart failure trial, testing associations and their mediators between the N-terminal B-type natriuretic peptide (NT-proBNP) and anxiety at baseline and over 12-month follow-up. Anxiety was measured by the Hospital Anxiety and Depression Scale (HADS), social support by the ENRICHD Social Support Inventory and physical functioning by the Short Form 36 Health Survey.
RESULTS
The mean age of the study population was 66.8 ± 7.6 years, 47.6% were male and 86.0% had NYHA class II. NT-proBNP showed a weak negative correlation with HADS anxiety scores at baseline (r = - 0.087; p = 0.092), which was significant (r = - 0.165; p = 0.028) in men but not in women. NT-proBNP also tended to predict lower anxiety at 12-months in men. On the other hand, higher anxiety at baseline was associated with lower NT-proBNP scores 12 months later (r = - 0.116; p = 0.026). All associations lost significance in multivariate regression for age, perceived social support (ESSI), physical function (SF-36) and study arm. Mediation analyses revealed that social support acts as a full mediator for the link between NT-proBNP levels and anxiety.
CONCLUSION
The mechanisms linking NT-proBNP to anxiety may be more complex than originally assumed. While effects of NT-proBNP on anxiety may be mediated by perceived social support, there may be an additional negative effect of anxiety on NT-proBNP. Future research should consider this possible bi-directionality of the association and assess the potential influence of gender, social support, oxytocin and vagal tone on the interaction of anxiety and natriuretic peptide levels. Trial Registration http://www.controlled-trials.com (ISRCTN94726526) on 07/11/2006. Eudra-CT-number: 2006-002,605-31.
背景
实验研究和一些患者样本表明，较高的血浆利钠肽（NP）水平与焦虑程度降低有关。由于心力衰竭患者的 NP 水平升高，我们研究了 NP 水平升高是否与射血分数保留的心力衰竭（HFpEF）患者的焦虑有关。
方法
使用随机、安慰剂对照、双盲、双臂、多中心醛固酮在舒张性心力衰竭试验中的 422 名 HFpEF 患者的数据进行了事后回归和中介分析，以检验基线和 12 个月随访期间 NP 与焦虑之间的关联及其中介物。焦虑采用医院焦虑抑郁量表（HADS）测量，社会支持采用 ENRICHD 社会支持量表测量，身体功能采用 SF-36 健康调查量表测量。
结果
研究人群的平均年龄为 66.8±7.6 岁，47.6%为男性，86.0%为纽约心脏协会（NYHA）心功能 II 级。NP 与基线时 HADS 焦虑评分呈弱负相关（r=-0.087；p=0.092），男性呈显著相关（r=-0.165；p=0.028），女性则不相关。NP 也倾向于预测男性 12 个月时的焦虑程度降低。另一方面，基线时焦虑程度较高与 12 个月时 NP 评分较低相关（r=-0.116；p=0.026）。多元回归分析中，年龄、感知社会支持（ESSI）、身体功能（SF-36）和研究组均使所有相关性失去意义。中介分析表明，社会支持是 NP 水平与焦虑之间关系的完全中介。
结论
将 NP 与焦虑联系起来的机制可能比最初假设的更为复杂。虽然 NP 对焦虑的影响可能通过感知的社会支持来介导，但焦虑对 NP 也可能有额外的负向影响。未来的研究应考虑到这种关联的可能双向性，并评估性别、社会支持、催产素和迷走神经张力对焦虑和利钠肽水平相互作用的潜在影响。试验注册网址：http://www.controlled-trials.com（ISRCTN）于 2006 年 11 月 7 日注册。Eudra-CT 编号：2006-002，605-31。
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