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

发布时间：2019-01-10 18:56

【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(T_0)、术后1 d(T_1)、3 d(T_2)、1周(T_3)和1个月(T_4)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T_0比较,研究组T_1、T_3和T_4的血浆NT-proBNP和TC浓度均降低(P0.05)。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(P0.05)。ROC分析结果显示,以728.28 pg/m L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。
[Abstract]:Objective to study the value of plasma N-terminal brain natriuretic peptide precursor (N-terminal brain natriuretic peptide precursor,NT-proBNP) and total cholesterol (total cholesterol,TC) in predicting malignant arrhythmia (malignant arrhythmia,MA) in patients with valvular heart disease. Methods 168 patients with valvular heart disease were selected as study group and 30 healthy examiners as control group. Enzyme linked immunosorbent assay (enzyme-linked immunosorbent,ELISA) was used to detect the changes of the control group and the study group before operation, 1 day after operation (T _ s _ 1), 3 days (T _ s _ 2). Plasma NT-proBNP and TC concentrations were measured at 1 week (T _ 3) and 1 month (T _ C _ 4). The statistical study group was followed up for 2 years. According to the occurrence of MA, the study group was divided into two subgroups: MA group (nnm18) and non-MA group (NN150). The plasma NT-proBNP and TC concentrations were compared between the two groups during perioperative period and the value of MA was predicted by analyzing the plasma NT-proBNP and TC concentrations in patients with valvular disease by means of (receiver operating characteristic curve,ROC. Results compared with the control group, the plasma NT-proBNP and TC concentrations in the study group were higher than those in the control group, and the plasma NT-proBNP and TC concentrations in the study group were lower than those in the control group (P0.05). The incidence of MA in the study group was 10.71% (18 / 168), and the plasma T-proBNP and TC levels in the MA group were significantly higher than those in the non-MA group (P0.05). ROC analysis). Using 728.28 pg/m L and 4.15 mmol/L as critical values of plasma NT-proBNP and TC, 17 patients with MA on 95%CI:0.791~0.936), ROC had a sensitivity of 94.444.148 patients with non-MA under the curve. The specificity was 98.67. The accuracy, positive predictive value and negative predictive value were 98.21, 89.47% and 99.33, respectively. The plasma NT-proBNP and TC concentrations in patients with valvular heart disease combined to predict the value of MA were good. Conclusion the plasma levels of NT-proBNP and TC in patients with valvular heart disease are both high and the value of the combined prediction of MA is good, which may be related to the relationship between NT-proBNP and cardiac function injury and the role of TC in regulating the electrolyte balance in the heart. Therefore, plasma NT-proBNP and TC concentrations in patients with valvular heart disease may be used to predict MA and provide evidence for prognosis improvement.
【作者单位】：河北省人民医院感染性疾病科;河北省人民医院超声科;河北省邯郸市第七医院内科;
【分类号】：R541.7

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