血浆NT-proBNP和总胆固醇浓度联合预测心脏瓣膜病病人恶性心律失常的价值

doi:10.3969/j.issn.1006-7795.2017.01.022

摘要/Abstract

摘要： 目的探讨血浆N端脑利钠肽前体（N-terminal brain natriuretic peptide precursor，NT-proBNP）和总胆固醇（total cholesterol，TC）浓度联合预测心脏瓣膜病病人恶性心律失常（malignant arrhythmia，MA）的价值。方法以心脏瓣膜病病人168例作为研究组，另选取30例同期健康查体者作为对照组。采用酶联免疫吸附法（enzyme-linked immunosorbent，ELISA）检测对照组和研究组术前（T₀）、术后1 d（T₁）、3 d（T₂）、1周（T₃）和1个月（T₄）的血浆NT-proBNP和TC浓度。统计研究组随访2年期间MA的发生情况，并根据其MA发生情况分为MA组（n=18）和非MA组（n=150）2个亚组，比较2组围术期的血浆NT-proBNP和TC浓度并采用受试者操作特征曲线（receiver operating characteristic curve，ROC）分析心脏瓣膜病病人血浆NT-proBNP和TC浓度预测其MA的价值。结果与对照组比较，研究组围术期的血浆NT-proBNP和TC浓度均升高；与T₀比较，研究组T₁、T₃和T₄的血浆NT-proBNP和TC浓度均降低（P<0.05）。研究组MA发生率为10.71%（18/168），且MA组围术期的血浆T-proBNP和TC水平均高于非MA组（P<0.05）。ROC分析结果显示，以728.28 pg/mL和4.15 mmol/L为血浆NT-proBNP和TC浓度临界值时AUC=0.884（95%CI：0.791~0.936），ROC上MA病人17例，灵敏度为94.44%，曲线下非MA病人148例，特异度为98.67%，准确性、阳性预测值和阴性预测值分别为98.21%、89.47%和99.33%，心脏瓣膜病病人血浆NT-proBNP和TC浓度联合预测其MA的价值良好。结论心脏瓣膜病病人血浆NT-proBNP和TC浓度均较高且两者联合预测其MA的价值良好，这可能与NT-proBNP与病人心功能损伤相关和TC调节心脏电解质平衡作用相关，因此心脏瓣膜病病人血浆NT-proBNP和TC浓度可能用于其MA的预测从而为其预后改善提供依据。

关键词: 血浆N端脑利钠肽前体, 胆固醇, 预测, 心脏瓣膜病, 恶性心律失常

Abstract: Objective To investigate the value of plasma N-terminal brain natriuretic peptide precursor (NT-proBNP) and total cholesterol (TC) levels of patients with heart valve disease predicting malignant arrhythmia(MA). Methods Totally 168 patients with heart valve disease were selected to constitute a research group, and other 30 healthy persons who had physical examination in the same period were selected to constitute a control group. Enzyme-linked immunosorbent (ELISA) was applied in detection of plasma NT-proBNP and TC levels of the control group and the research group preoperative (T₀), postoperative 1d (T₁), 3d (T₂), 1 week (T₃), and 1 month (T₄). The research group was followed up for two years and the occurrence of MA was statistically analyzed. The research groups were divided into MA group (n=18) and non-MA group(n=150) two subgroups according to the occurrence of MA. perioperative plasma NT-proBNP and TC levels of MA group and non-MA group were compared and receiver operating characteristic curve (ROC) was applied in analysis of value of plasma NT-proBNP and TC levels of patients with heart valve disease predicting the MA. Results Compared with control group, perioperative plasma NT-proBNP and TC levels of the research group were increased; compared with T₀, T₁, T₃ and T₄ plasma NT-proBNP and TC levels of the research group were lower (P<0.05). MA incidence of the research group was 10.71% (18/168), and perioperative plasma NT-proBNP and TC levels of MA group were higher than that of non-MA group (P<0.05). ROC curve analysis results showed that when the cutoff valued of plasma NT-proBNP and TC level were 728.28 pg/mL and 4.15 mmol/L, the AUC=0.884(95%CI:0.791-0.936), there was 17 patients with MA on the curve, thus the sensitivity was 94.44%, and there was 148 cases of patients without MA under the curve, thus the specificity was 98.67%, and the accuracy, positive predictive value and negative predictive value were 98.21%, 89.47% and 99.33% respectively. Value of plasma NT-proBNP and TC levels of patients with heart valve disease predicting MA was good. Conclusion Plasma NT-proBNP and TC levels of patients with heart valve disease were higher and the value of the two above items unitedly predicting MA is good. This may be associated with the NT-proBNP relating with cardiac function injury and TC regulating heart electrolyte balance effect, thus plasma NT-proBNP and TC levels of patients with heart valve disease could predict MA and thus to provide basis for improving outcomes.

Key words: N-terminal brain natriuretic peptide precursor(NT-proBNP), cholesterol, predict, heart valve disease, malignant arrhythmia

中图分类号:

R541.7

李春芝, 赵鑫, 郭士强. 血浆NT-proBNP和总胆固醇浓度联合预测心脏瓣膜病病人恶性心律失常的价值[J]. 首都医科大学学报, 2017, 38(1): 108-112.

Li Chunzhi, Zhao Xin, Guo Shiqiang. Value of plasma NT-proBNP and total cholesterol levels of patients with heart valve disease predicting malignant arrhythmia[J]. Journal of Capital Medical University, 2017, 38(1): 108-112.

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