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[1]章荣华,陈丞,邵先安,等.脑钠肽水平低于诊断阈值的终末期心衰患者的影响因素分析[J].医学研究与战创伤救治(原医学研究生学报),2022,24(6):608-613.[doi:10.3969/j.issn.1672-271X.2022.06.010]
　ZHANG Rong-hua,CHEN Cheng,SHAO Xian-an,et al.Analysis of risk factors in patients with end-stage heart failure whose brain natriuretic peptide level is below the diagnostic threshold[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(6):608-613.[doi:10.3969/j.issn.1672-271X.2022.06.010]
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脑钠肽水平低于诊断阈值的终末期心衰患者的影响因素分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年6期
页码:
608-613
栏目:
临床研究
出版日期:
2023-01-18

文章信息/Info

Title:
Analysis of risk factors in patients with end-stage heart failure whose brain natriuretic peptide level is below the diagnostic threshold
作者:
章荣华; 陈丞; 邵先安; 朱先存; 王静; 叶长青
作者单位：233015蚌埠，解放军联勤保障部队第九○二医院心内科（章荣华、邵先安、朱先存、王静、叶长青）；100853北京解放军总医院第二医学中心 国家老年疾病临床医学研究中心（陈丞）
Author(s):
ZHANG Rong-hua1;  CHEN Cheng2;  SHAO Xian-an1;  ZHU Xian-cun1;  WANG Jing1;  YE Chang-qing1
（1. Department of Cardiology of the 902nd Hospital of the Joint Logistic Support Force, Bengbu 233015, Anhui, China；2.National Clinical Medical Research Center for Geriatric Diseases, Second Medical Center, PLA General Hospital, Beijing 100853, China）
关键词:
终末期心衰; N端脑钠肽前体; 脑钠肽
Keywords:
end-stage heart failure; N-terminal pro-B type natriuretic peptide; brain natriuretic peptide
分类号:
R541.61
DOI:
10.3969/j.issn.1672-271X.2022.06.010
文献标志码:
A
摘要:
目的初步探讨N端脑钠肽前体（NT-proBNP）、脑钠肽（BNP）水平低于诊断阈值的终末期心衰患者的影响因素。方法回顾性分析2018年8月至2021年12月解放军联勤保障部队第九○二医院心内科收治的153例终末期心衰患者(NYHA Ⅲ-Ⅳ级)，检测患者BNP/NT-proBNP水平，依据脑钠肽复合界值法，将BNP/NT-proBNP低于诊断标准的心衰患者分类到低脑钠肽组(45例)，符合该诊断标准的分类到高脑钠肽组(108例)；统计血常规、生化及心脏超声参数，采用卡方检验、Logistic多因素回归分析、Spearman相关分析等，探索BNP/NT-proBNP低于诊断阈值的相关因素。结果终末期心衰患者BNP/NT-proBNP水平受血脂及左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、左房舒张末期内径(LADd)、左室射血分数（LVEF）及心功能分级影响。Logistic回归显示低脑钠肽组TC［4.66(3.22，5.52)mmol/L］、TG［1.42（0.97，1.97）mmol/L］、LDL-C［3.05(1.8，3.78)mmol/L］、LVEF［66(57，71)%］均较高脑钠肽组TC［3.62(3.18，4.33)mmol/L］、TG［1.04（0.8，1.37）mmol/L］、LDL-C［1.99(1.67，2.64)mmol/L］、LVEF［49(35，64)%］显著增高（P均<0.05);而低脑钠肽组LVDd［47(43.5，50)mm］、LVDs［29(26.5，36)mm］、LADd［39(33.5，43.5)mm］均低于高脑钠肽组LVDd［52(46，61)mm］、LVDs［3.9(30，49)mm］、LADd［46(41，50)mm］（P均<0.05）。高脂血症（OR=3.006，P<0.05）和小LADd（OR=0.419，P<0.05）是低脑钠肽患者的风险因素。NT-proBNP与胆固醇(TC)（r=-0.3961,P<0.0001）、甘油三酯（TG）（r=-0.3145,P=0.0012）、低密度脂蛋白（LDL-C）（r=-0.3923,P<0.0001）均呈显著的负相关；BNP与TC（r=0.0244,P=0.8662）、LDL-C（r=0.0293,P=0.8400）相关性分析无统计学意义，与TG（r=-0.3050,P=0.0331）呈负相关。结论终末期心衰患者的BNP/NT-proBNP水平有可能低于诊断阈值，脑钠肽水平与血脂高低以及LADd密切相关。对于患有高脂血症以及LADd小的患者，脑钠肽（BNP/NT-proBNP）水平有时不能真实反映患者的心衰严重程度，需结合患者基础疾病、临床症状、心脏超声等综合判断。
Abstract:
ObjectiveThis study aimed to explore the risk factors of N-terminal pro-B type natriuretic peptide (NT-proBNP) or Brain Natriuretic Peptide(BNP) level below the diagnostic threshold in patients with end-stage heart failure.MethodsA retrospective analysis was performed on 153 patients with end-stage heart failure (NYHA Ⅲ-Ⅳ) admitted to the Department of Cardiology of the 902nd Hospital of the Joint Logistic Support Force from August 2018 to December 2021. BNP/NT-proBNP levels of the patients were detected. BNP/NT-proBNP is lower than the diagnostic criteria of heart failure patients classified to low brain natriuretic peptide group (45 patients), in line with the diagnostic criteria of classification to high brain natriuretic peptide group (108 patients); Blood routine, biochemical and cardiac ultrasound parameters were analyzed. A Chi-square test, Logistic multivariate regression analysis and Spearman correlation analysis were used to explore the related factors of BNP/NT-proBNP lower than the diagnostic threshold.ResultsThe levels of BNP/NT-proBNP in patients with end-stage heart failure were significantly affected by blood lipids and left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left atrial end-diastolic diameter (LADd),left ventricular ejection fraction (LVEF)and cardiac functional grading. Logistic regression showed that TC [4.66(3.22, 5.52)mmol/L], TG [1.42 (0.97, 1.97)mmol/L], LDL-C [3.05(1.8，3.78)mmol/L], LVEF [66(57, 71)%]in the low brain natriuretic peptide group were higher than the TC［3.62(3.18，4.33)mmol/L］，TG［1.04（0.8，1.37）mmol/L］，LDL-C［1.99(1.67，2.64)mmol/L］，LVEF［49(35，64)%］in the high brain natriuretic peptide group;while the LVDd［47(43.5，50)mm］，LVDs［29(26.5，36)mm］，LADd［39(33.5，43.5)mm］ were lower than the LVDd［52(46，61)mm］，LVDs［39(30，49)mm］，LADd［46(41，50)mm］（P<0.05）in the high brain natriuretic peptide group; Hyperlipidemia（OR=3.006，P<0.05）and small LADd（OR=0.419，P<0.05）were independent risk factors for patients with low brain natriuretic peptide; NT-proBNP and cholesterol (TC) (r=-0.3961, P<0.0001), triglyceride (TG) (r=-0.3145,P=0.0012), low-density lipoprotein (LDL-C) (r=-0.3923) , P<0.0001) have a significant negative correlation;BNP was not significantly correlated with TC (r=0.0244,P=0.8662) and LDL-C(r=0.0293,P=0.8400), but negatively correlated with TG (r=-0.3050,P=0.0331).ConclusionThis study found that the level of BNP/NT-proBNP in patients with end-stage heart failure may be lower than the diagnostic threshold, and the level of brain natriuretic peptide is closely related to the level of blood lipid and LADd. For patients with hyperlipidemia and small LADd, brain natriuretic peptide (BNP/NT-proBNP) level sometimes can not truly reflect the severity of heart failure in patients, need to be combined with the patient’s underlying disease, clinical symptoms, cardiac ultrasound and other comprehensive judgment.

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备注/Memo

备注/Memo:
基金项目：南京军区医学重点课题资助项目（14ZD20）
更新日期/Last Update: 2023-01-18