JACC发表阜外医院吴永健等CHINA-DVD研究：NT-proBNP可预测中重度瓣膜病者死亡风险

2020-04-11 朱朱中国循环杂志

zehuiwang

医生/ 护师

近日，阜外医院吴永健教授等代表CHINA-DVD研究组发表在JACC上的最新研究结果表明，N末端B型利钠肽原（NT-proBNP）可预测中重度瓣膜性心脏病患者的预后。

近日，阜外医院吴永健教授等代表CHINA-DVD研究组发表在JACC上的最新研究结果表明，N末端B型利钠肽原（NT-proBNP）可预测中重度瓣膜性心脏病患者的预后。

研究者认为，NT-proBNP可能有助于对老年瓣膜性心脏病患者进行危险分层。

相关述评指出，该研究表明，在超声心动图检查的基础上，仅检测血NT-proBNP这一个指标就能显著提高对中重度瓣膜性心脏病患者的预后预测能力。

述评作者认为，“应考虑将血清NT-proBNP水平作为评估和监测瓣膜性心脏病患者的基石，以给予及时干预。”在患者获得影像学复查机会较少的发展中国家，简单检测利钠肽水平可能在瓣膜性心脏病患者的随访和治疗决策制定中很有用。

该研究显示，基线NT-proBNP比值较高的瓣膜性心脏病患者，1年后死亡的风险约增加了1倍。

基线NT-proBNP比值是指所测NT-proBNP水平与校正年龄和性别后的NT-proBNP水平正常最高值的比值。

在该研究中，患者的基线NT-proBNP比值中位数为13.1（NT-proBNP绝对值为1 944pg/ml）。93.2%的患者基线NT-proBNP比值均升高（>1），多瓣膜心脏病患者中最高，主动脉瓣狭窄患者中最低。

除了二尖瓣狭窄患者，在其他各种瓣膜性心脏病患者中，基线NT-proBNP比值较高者的1年死亡风险均增加。

其中，主动脉瓣狭窄患者尤其显著，基线NT-proBNP比值较高者1年后死亡风险增加了9.5倍。

各种瓣膜性心脏病患者中基线NT-proBNP比值与1年死亡风险之间的关系

基线NT-proBNP比值或绝对水平较高与瓣膜疾病严重程度或NYHA心功能分级显著相关。

在累及左心的瓣膜性心脏病患者中，基线NT-proBNP比值与左心室大小之间的正相关关系在主动脉瓣关闭不全患者中最明显，其次是二尖瓣关闭不全患者，在主动脉瓣狭窄患者中也比较明显。

在所有类型瓣膜性心脏病患者中，左心室射血分数与基线NT-proBNP比值均有紧密关联。

将基线NT-proBNP比值添加到包含左心室射血分数等传统危险因素的预后预测模型中后，该模型的预测能力明显改善，在主动脉瓣狭窄和主动脉瓣关闭不全患者中预测能力提高最为明显。

亚组分析显示，在接受治疗、左心室射血分数正常（≥50%）的患者以及原发性瓣膜性心脏病患者中，基线NT-proBNP比值也与1年死亡风险独立相关。

该研究从全国69家医疗中心纳入5983例年龄≥60岁（平均年龄为71.1岁）的中重度瓣膜性心脏病患者，包括主动脉瓣狭窄（5%）、主动脉瓣关闭不全（10%）、二尖瓣狭窄（3%）、二尖瓣关闭不全（27%）、三尖瓣关闭不全（17%）、多瓣膜心脏病（38%）。

大约1/3的患者合并冠心病，一半患者合并高血压，1/5的患者合并糖尿病。随访1年时，死亡率为9.4%。

来源：

[1]Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease. J Am Coll Cardiol, 2020, 75(14): 1659-1672.

[2]NT-proBNP as a Cornerstone for Prognosis in Valve Disease: All We Need Is Blood. J Am Coll Cardiol, 2020, 75(14): 1673-1675.

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2020-07-21 hbwxf

#JACC#

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2020-04-13 drwjr

#CHINA#

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time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-11-20 thinkibmz_44722594

#阜外医#

73 0
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time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-04-13 quxin068

#死亡风险#

66 0
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href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583663, encodeId=c1be15836632d, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-04-13 huiwelcome

#BNP#

78 0
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href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583663, encodeId=c1be15836632d, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-04-13 mjldent

#NT-proBNP#

83 0
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2020-04-13 jj000001

#阜外医院#

73 0
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2020-04-13 12498568m50暂无昵称

#ACC#

55 0
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time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-04-13 12498e5fm17(暂无昵称)

#瓣膜#

59 0
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channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1293760, encodeId=2aea1293e607d, content=<a href='/topic/show?id=4c6e9e34931' target=_blank style='color:#2F92EE;'>#阜外医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97349, encryptionId=4c6e9e34931, topicName=阜外医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326578, encodeId=47ae13265e8ee, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583663, encodeId=c1be15836632d, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602261, encodeId=64d2160226143, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Apr 13 02:35:57 CST 2020, time=2020-04-13, status=1, ipAttribution=)]
2020-04-13 sunylz

#PRO#

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