The diagnosis value of plasma mid-regional pro-atrial natriuretic peptide in patients with heart failure complicated with atrial fibrillation
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摘要: 目的 分析血浆心房利钠肽原中间片段(MR-proANP)在心力衰竭(HF)合并心房颤动(AF)患者中的诊断价值。方法 选取河北省人民医院心血管内科住院的慢性HF患者207例，并纳入无HF及AF诊断但患有冠心病、糖尿病等57例为对照组。按照院前有无AF将HF分为窦性心律HF(HF-SR)组和HF合并AF(HF-AF)组，比较这3组患者基本资料差异。ROC曲线评价MR-proANP对HF-AF的诊断价值。结果 ① MR-proANP在3组患者中的差异有统计学意义(P＜0.05)。②左房内径(LAD)、MR-proANP在HF-AF组与HF-SR组中的差异有统计学意义(P＜0.017)。③ROC分析显示，在HF-AF患者中，以对照组作为对照，MR-proANP诊断HF-AF的曲线下面积(AUC)为0.946(95%CI：0.913~0.979，P＜0.001)，诊断HF-AF的灵敏度为86.8%，特异度为96.5%；以HF-SR组作为对照，MR-proANP诊断HF-AF的AUC为0.662(95%CI：0.588~0.736，P＜0.001)，灵敏度为68.9%，特异度为60.4%。结论 HF-AF患者组中LAD增大，MR-proANP浓度明显升高。MR-proANP对HF-AF患者具有诊断价值。
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关键词:
- 心房利钠肽原中间片段 /
- 心力衰竭 /
- 心房颤动 /
- 诊断 /
- 生物标记物
Abstract: Objective To analyze the diagnostic value of plasma atrial natriuretic peptide intermediate fragment(MR-proANP) in patients with heart failure(HF) complicated with atrial fibrillation(AF).Methods A total of 207 patients with chronic HF who were hospitalized in the Department of Cardiology of Hebei Provincial People's Hospital were selected, and 57 patients without HF and AF diagnosis but suffering from coronary heart disease and diabetes were included in the control group. HF cases were divided into sinus rhythm HF(HF-SR) group and HF with AF(HF-AF) group according to the presence or absence of AF before hospital, and the differences in basic data of the three groups were compared. The diagnostic value of MR-proANP in HF-AF was evaluated by ROC curve.Results ① The differences of MR-proANP among the three groups were statistically significant(P< 0.05). ②The left atrial diameter(LAD) and MR-proANP were significantly different between the HF-AF group and the HF-SR group(P< 0.017). ③ ROC analysis showed that in HF-AF patients, with the control group as the control, the area under the curve(AUC) of MR-proANP in the diagnosis of HF-AF was 0.946(95%CI: 0.913~0.979,P< 0.001), the sensitivity was 86.8% and the specificity was 96.5%. Taking the HF-SR group as a control, the AUC of MR-proANP in the diagnosis of HF-AF was 0.662(95%CI: 0.588-0.736,P< 0.001), and the sensitivity was 68.9%, and the specificity of 60.4%.Conclusion The LAD and MR-proANP concentration increased significantly in the HF-AF patients. MR-proANP has diagnostic value in HF-AF patients. -
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图 1 MR-proANP与NT-proBNP在鉴别HF-AF与对照组的ROC曲线
Figure 1. ROC curve of MR-proANP and NT-proBNP in differentiating HF-AF and control group
图 2 MR-proANP与NT-proBNP在鉴别HF-SR与对照组的ROC曲线
Figure 2. ROC curve of MR-proANP and NT-proBNP in differentiating HF-SR and control group
图 3 MR-proANP与NT-proBNP在鉴别HF-AF与HF-SR的ROC曲线
Figure 3. ROC curves of MR-proANP and NT-proBNP in differentiating HF-AF and HF-SR
表 1 3组的一般情况比较
Table 1. General data
例(%), M(P25, P75) 项目 HF-SR组(101例) HF-AF组(106例) 对照组(57例) P值 年龄/岁 68.0(56.0，76.0) 75.0(66.0，81.0) 68.0(60.0，74.0) ＜0.001 男性 65(64.4) 75(70.8) 32(56.1) 0.171 心率/(次·min-1) 82.0(71.0，95.0) 87.0(73.0，108.0) 75.0(68.0，90.0) 0.004 BMI/(kg·m-2) 25.4(22.0，29.4) 24.9(23.3，26.8) 25.0(23.2，26.4) 0.353 SBP/mmHg 133.0(114.0，149.0) 130.0(110.0，146.0) 136.0(126.0，145.0) 0.102 DBP/mmHg 78.0(67.0，88.0) 78.0(68.0，93.0) 78.0(70.0，87.0) 0.773 NYHA心功能分级 - - - 0.125 Ⅱ级 13(12.9) 15(14.2) - - Ⅲ级 52(51.5) 40(37.7) - - Ⅳ级 36(35.6) 51(48.1) - - 吸烟史 23(22.8) 29(27.4) 12(21.1) 0.608 饮酒史 20(19.8) 25(23.6) 6(10.5) 0.130 冠心病史 52(51.5) 42(39.6) 30(52.6) 0.145 糖尿病史 29(28.7) 50(47.2) 13(22.8) 0.002 高血压分级 - - - 0.610 Ⅰ级 3(3.0) 4(3.8) - - Ⅱ级 11(10.9) 15(14.2) 11(19.3) - Ⅲ级 45(44.5) 45(42.5) 27(47.4) - 陈旧性脑梗死 27(26.7) 41(38.7) 15(26.3) 0.116 血红蛋白/(g·L-1) 135.0(119.0，151.0) 130.0(110.0，145.0) 135.0(122.0，144.0) 0.165 ALT/(U·L-1) 16.1(12.7，26.4) 19.3(13.1，28.8) 16.0(11.8，21.1) 0.107 AST/(U·L-1) 20.3(16.6，30.0) 22.7(17.7，34.1) 19.3(17.4，23.8) 0.024 LDL-C/(mmol·L-1) 2.4(2.1，3.2) 2.2(1.6，2.8) 2.7(2.3，3.2) ＜0.001 TC/(mmol·L-1) 4.0(3.1，4.6) 3.2(2.6，4.2) 4.2(3.6，4.8) ＜0.001 尿酸/(μmol·L-1) 460.8(364.5，563.9) 451.4(374.5，576.0) 302.8(251.7，357.7) ＜0.001 尿素氮/(mmol·L-1) 7.0(5.5，10.6) 8.2(5.5，11.6) 4.7(4.1，5.4) ＜0.001 肌酐/(μmol·L-1) 86.8(73.2，117.1) 99.2(80.3，137.0) 69.0(61.0，74.9) ＜0.001 GFR/(mL·min-1) 71.6(50.7，89.0) 61.3(40.4，84.9) 90.9(82.3，96.0) ＜0.001 LAD/mm 43.0(41.0，48.0) 48.0(43.0，52.0) 36.0(34.0，38.0) ＜0.001 LVEF/% 45.0(38.0，54.0) 46.0(33.0，59.0) 65.0(63.0，68.0) ＜0.001 LVEDD/mm 56.0(49.0，63.0) 54.0(47.0，60.0) 46.0(43.0，47.0) ＜0.001 cTnT/(ng·L-1) 40.0(40.0，50.0) 40.0(40.0，43.0) 40.0(40.0，40.0) 0.001 NT-proBNP/(pg·mL-1) 3734.0(919.5，9000.0) 4281.0(1722.8，9000.0) 87.0(60.0，161.5) ＜0.001 MR-proANP/(pg·mL-1) 393.0(229.5，560.5) 551.5(379.0，734.3) 162.0(107.5，214.0) ＜0.001 注：BMI：体质指数；SBP：收缩压；DBP：舒张压；ALT：丙氨酸转氨酶；AST：天冬氨酸转氨酶；LDL-C：低密度脂蛋白胆固醇；TC：总胆固醇；GFR：肾小球滤过率；cTnT：心肌肌钙蛋白T。 
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表 2 3组一般情况的两两比较
Table 2. Pairwise comparison of the general data of the three groups
项目 α分割法(0，1) α分割法(0，2) α分割法(1，2) 年龄 ＜0.001 0.294 ＜0.001 心率 ＜0.001 0.031 0.019 糖尿病史 ＜0.001 0.140 0.002 肌酐 ＜0.001 ＜0.001 0.041 尿酸 ＜0.001 ＜0.001 0.241 尿素氮 ＜0.001 ＜0.001 0.110 AST 0.002 0.048 0.048 TC ＜0.001 0.056 ＜0.001 LDL-C ＜0.001 0.106 ＜0.001 GFR ＜0.001 ＜0.001 0.009 LVEF ＜0.001 ＜0.001 0.057 LAD ＜0.001 ＜0.001 ＜0.001 LVEDD ＜0.001 ＜0.001 0.012 cTnT 0.004 ＜0.001 0.042 NT-proBNP ＜0.001 ＜0.001 0.131 MR-proANP ＜0.001 ＜0.001 ＜0.001 注：多样本秩和检验及卡方检验提示上述指标P＜0.05，采用α分割法进行多重比较，检验水准P＜0.017(0.05/3)为差异有统计学意义。(0，1)表示对照组与HF-AF组两两比较；(0，2)表示对照组与HF-SR组两两比较；(1，2)表示HF-AF组与HF-SR组两两比较。
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表 3 MR-proANP与NT-proBNP诊断HF-SR/HF-AF的价值
Table 3. Values of MR-proANP and NT-proBNP in the diagnosis of HF-SR/HF-AF
指标 用途 AUC(95%CI) P值 截断值/(pg·mL-1) 灵敏度/% 特异度/% MR-proANP HF-SR/对照组 0.857(0.801~0.914) ＜0.001 312.5 65.3 98.2 HF-AF/对照组 0.946(0.913~0.979) ＜0.001 294 86.8 96.5 HF-AF/HF-SR 0.662(0.588~0.736) ＜0.001 438 68.9 60.4 NT-proBNP HF-SR/对照组 0.981(0.965~0.997) ＜0.001 275.5 98.0 89.5 HF-AF/对照组 0.990(0.980~1.000) ＜0.001 714.5 91.5 98.2 HF-AF/HF-SR 0.541(0.462~0.620) 0.305 1463 81.1 34.7
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