Prognostic Value of eGFR and NT-proBNP in Patients with Chronic Heart Failure Complicated with Atrial Fibrillation
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摘要:
目的 探讨eGFR和血清NT-proBNP对慢性心力衰竭合并房颤患者预后的预测价值。 方法 选取2018年1月至2019年12月期间住院的慢性心力衰竭合并房颤患者139例。测定患者的血清肌酐及NT-proBNP，根据肾脏病膳食改良预测方程计算患者的估测肾小球滤过率（eGFR）。随访入选患者出院后的全因死亡情况。应用Logistic回归分析慢性心力衰竭合并房颤患者随访期间发生全因死亡的危险因素。采用ROC曲线分析eGFR和血清NT-proBNP在慢性心力衰竭合并房颤患者预后中的价值。生存分析使用Kaplan-Meier法，检验用Log-rank法。 结果 随访期间有65例患者死亡，发生率为46.76%。eGFR预测慢性心力衰竭合并房颤患者不发生全因死亡的曲线下面积为0.651（95%CI：0.562～0.740），敏感度为57.70%，特异度为69.20%。血清NT-proBNP预测慢性心力衰竭合并房颤患者发生全因死亡的曲线下面积为0.720（95%CI：0.638～0.803），敏感度为69.20%，特异度为67.30%。eGFR低水平组患者随访期间累积生存率明显低于eGFR高水平组，Log-rank的检验统计值为9.21，P = 0.002。NT-proBNP高水平组患者随访期间累积生存率明显低于NT-proBNP低水平组，Log-rank的检验统计值为16.91，P < 0.001。 结论 eGFR和血清NT-proBNP对慢性心力衰竭合并房颤患者的近期预后有一定预测价值。 Abstract:Objective To investigate the prognostic value of eGFR and serum NT-proBNP in patients with chronic heart failure complicated with atrial fibrillation. Methods From January 2018 to December 2019, 139 hospitalized patients with chronic heart failure complicated with atrial fibrillation were selected. The serum creatinine and NT-proBNP of the patients were measured, and the estimated glomerular filtration rate （eGFR） of the patients was calculated according to theequationofModification of Diet in Renal Disease. All-cause deaths after discharge were followed up. Logistic regression was used to analyze the risk factors of all-cause death in chronic heart failure complicated with atrial fibrillation during the follow-up period. ROC curve was used to analyze the prognostic value of eGFR and serum NT-proBNP in patients with chronic heart failure complicated with atrial fibrillation.Kaplan-meier method was used to draw the survival curve, and log-rank test was used for survival analysis. Results During the follow-up, 65 patients were found dead. The incidence was 46.76%. The area under the curve of eGFR-in predicting the absence of all-cause death in patients with chronic heart failure and atrial fibrillation was 0.651 （95%CI: 0.562 ～ 0.740）.The sensitivity was 57.70%, and the specificity was 69.20%. The area under the curve of serum NT-proBNP for predicting all-cause death in patients with chronic heart failure complicated with atrial fibrillation was 0.720 （95%CI: 0.638 ～ 0.803）.The sensitivity was 69.20%, and the specificity was 67.30%. The cumulative survival rate of patients in the low-eGFR group was significantly lower than that in the high-eGFR group during follow-up. The Log-rank value was 9.21, P = 0.002. During the follow-up, the cumulative survival rate of patients in the high level of NT-proBNP group was significantly lower than that in the low level of NT-proBNP group. The statistical value of Log-rank test was 16.91, P < 0.001. Conclusion eGFR and serum NT-proBNP have certain predictive value for the short-term prognosis of patients with chronic heart failure complicated with atrial fibrillation. -
图 1 eGFR预测CHF合并Af患者不发生全因死亡的ROC曲线
Figure 1. ROC curve of eGFR in predicting the absence of all-cause death in patients with CHF complicated with Af
图 2 血清NT-proBNP预测CHF合并Af患者发生全因死亡的ROC曲线
Figure 2. Serum NT-proBNP predicted the ROC curve of all-cause death in patients with CHF complicated with Af
图 3 不同eGFR分组的CHF合并Af患者随访期间累积生存率情况的比较
Figure 3. Comparison of follow-up cumulative survival rate in patients with CHF combined with Af in different eGFR groups
图 4 不同NT-proBNP分组的CHF合并Af患者随访期间累积生存率情况的比较
Figure 4. Comparison of follow-up cumulative survival rate in patients with CHF combined with Af in different NT-proBNP groups
表 1 入选患者的基本特征[
$ \bar x \pm s $ /n（%）]Table 1. Basic characteristics of the selected patients [
$ \bar x \pm s$ /n（%）]基本特征 具体值 年龄（岁） 73.68 ± 9.21 男性 57（41.01） 心功能分级 心功能II级 4（2.88） 心功能III级 27（19.42） 心功能IV级 108（77.70） 基础心脏病 冠心病 97（69.78） 心脏瓣膜病 20 （14.39） 心肌病 12 （8.63） 高血压性心脏病 5（3.60） 其他 5（3.60） 血清肌酐（μmol/L） 96.47 ± 38.39 Lg（NT-proBNP） 3.55 ± 0.47 eGFR[mL/（min·1.73m2）] 84.55 ± 31.63 左室射血分数 0.49 ± 0.13 注：Lg（NT-proBNP）为NT-proBNP的对数值。 
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表 2 Logistic回归分析入选患者随访期间发生全因死亡的危险因素
Table 2. Logistic regression analysis risk factors for all-cause death in selected patients during follow-up
变量 B SE Wald P OR 95%CI 年龄 0.040 0.270 2.231 0.135 1.041 0.988～1.096 性别 −0.599 0.573 1.095 0.295 0.549 0.179～1.688 心功能分级 −0.026 0.485 0.003 0.958 0.975 0.376～2.524 血清肌酐 0.000 0.013 0.002 0.968 0.999 0.974～1.025 NT-proBNP 0.000 0.000 6.295 0.012 1.000 1.000～1.000 eGFR 0.070 0.029 6.017 0.014 1.073 1.014～1.135 左室射血分数 −0.014 0.017 0.708 0.400 0.986 0.954～1.019
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