联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值

doi:10.3969/j.issn.1673-8640.2014.04.003

摘要/Abstract

摘要：

目的　探讨氨基末端B型钠尿肽原(NT-proBNP)、心型脂肪酸结合蛋白(H-FABP)和心肌肌钙蛋白I(cTnI)联合检测对老年重症心力衰竭 (HF)的临床价值。方法　检测312例老年重症HF患者入院时、治疗后第7天、第15天、第30天、第60天及对照组(76例老年非重症HF患者和40名健康体检者) NT-proBNP、H-FABP 和cTnI水平。所有患者平均随访180 d,记录随访期间发生的主要不良心脏事件(MACE)。根据是否发生MACE分为MACE组(其中再入院组110例、死亡组84例)和无MACE组118例。采用受试者工作特征(ROC)曲线评估3项指标对重症HF诊断和预测死亡风险的价值。采用Kaplan-Meier曲线做生存分析。结果　重症HF组入院时NT-proBNP、H-FABP 和cTnI水平明显高于对照组(P<0.01),其H-FABP阳性率为47.1％、cTnI阳性率为4.5％;且NT-proBNP水平与HF患者心功能分级[美国纽约心脏病协会(NYHA)Ⅰ～Ⅳ级]呈正相关(r＝0.77,P<0.01)。根据ROC曲线选取血清NT-proBNP、H-FABP和cTnI值分别为4 601.50 ng/L、5.16 ng/L和0.025 ng/mL及8 178.50 ng/L、11.77 ng/L和0.038 ng/mL作为重症HF诊断及死亡预测的临界值,可获最佳诊断价值。3项指标联合检测对重症HF诊断及死亡预测的敏感性高于单项检测(P<0.05)。治疗前,MACE组NT-porBNP水平明显高于无MACE组(P<0.05),死亡组H-FABP水平明显高于非死亡组(P<0.05),不同预后组cTnI水平差异无统计学意义(P>0.05)。治疗后第7天,无MACE组3项指标水平明显下降(P<0.05),且下降率均＞50%,H-FABP恢复正常;治疗后第15天,再入院组3项指标水平明显降低(P<0.05),但下降率均＜30%,H-FABP仍高于参考区间;死亡组在治疗过程中3项指标水平未降反升,治疗后第7天、第30天cTnI均阳性。Kaplan-Meier曲线分析表明,不同NT-porBNP、H-FABP 和cTnI水平的患者生存率有明显差异(P<0.05)。结论　定期联合检测NT-proBNP、H-FABP和cTnI水平对重症HF诊断、患者预后和死亡风险评估及疗效监测均有重要临床意义。

关键词: 氨基末端B型钠尿肽原, 心型脂肪酸结合蛋白, 肌钙蛋白I, 心力衰竭

Abstract:

Objective　To study the clinical significance on the combined determination of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein(H-FABP)and cardiac troponin I(cTnI)in elder patients with severe heart failure (HF). Methods　The serum NT-proBNP, H-FABP and cTnI levels were determined in 312 elder patients with severe HF ｛main adverse cardiovascular event (MACE)group(194 cases)[cardiogenic readmission group(110 cases) and death group(84 cases)]and no-MACE group(118 cases)｝on admission, day 7, 15, 30 and 60 after treatment, 76 elder patients with no-severe HF and 40 elder healthy subjects. The MACE were followed and observed for 180 d. The significance of NT-proBNP, H-FABP and cTnI for the diagnosis of severe HF and the prediction of death risk was analyzed by receiver operating characteristic(ROC)curve. Survival analysis was performed by Kaplan-Meier curve. Results　The serum NT-proBNP, H-FABP and cTnI levels in elder patients with severe HF were significantly higher than those in elder patients with no-severe HF and healthy subjects (P<0.01), the positive rate of H-FABP in elder patients with no-severe HF was 47.1％, and the positive rate of cTnI was 4.5％. The serum NT-proBNP levels were positively correlated with the grade of New York Heart Association (NYHA)Ⅰ-Ⅳ (r=0.77,P<0.01). The ROC curve indicated that the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for diagnosis in elder patients with severe HF were 4 601.50 ng/L, 5.16 ng/L and 0.025 ng/mL, and the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for the death risk evaluation in elder patients with severe HF were 8 178.50 ng/L, 11.77ng/L and 0.038ng/mL, respectively. The sensitivity of the combined determination was obviously better than those of the individual determinations (P<0.05). Before the treatment, the serum NT-proBNP levels in MACE group were significantly higher than those in no-MACE group(P<0.05), the serum H-FABP levels in death group were significantly higher than those in no-death group(P<0.05), and the serum cTnI levels in various prognosis groups had no statistical significance (P>0.05). The serum NT-proBNP, H-FABP and cTnI levels in no-MACE group on day 7 after treatment were significantly lower than those before the treatment (P<0.05). The decreasing rates of the 3 parameters were >50%, and the serum H-FABP level was lower than the normal reference value. The serum NT-proBNP, H-FABP and cTnI levels in the cardiogenic readmission group on day 15 after treatment were significantly lower than those before treatment(P<0.05), but the decreasing rates of the 3 parameters were <30%,and the serum H-FABP level was higher than the normal reference value. The serum NT-proBNP, H-FABP and cTnI levels in death group on day 7 and day 30 after treatment were significantly higher than those before treatment(P<0.05), and the serum cTnI levels were higher than the normal reference value. Kaplan-Meier survival curve showed that the survival rates of serum NT-proBNP, H-FABP and cTnI levels had significant difference(P<0.05). Conclusions　There is an important clinical significance of the combined determination of serum NT-proBNP, H-FABP and cTnI levels for the diagnosis, prognosis, death risk evaluation and curative effect survey in elder patients with severe HF.

Key words: N-terminal pro-B-type natriuretic peptide, Heart-type fatty acid-binding protein, Troponin I, Heart failure

中图分类号:

R446.1

伍树芝，邓胜，秦伟国，陈健，易斌. 联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值[J]. 检验医学, 2014, 29(4): 312-318.

WU Shuzhi，DENG Sheng，QIN Weiguo，CHEN Jian，YI Bin.. The clinical significance on the combined determination of NT-proBNP, H-FABP and cTnI in elder patients with severe heart failure[J]. , 2014, 29(4): 312-318.

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