目的 探讨脑钠肽(BNP)和血清胱抑素C(Cys-c)检测在致心律失常右室发育不良(ARVD)患者中心力衰竭预测及预后评估中的价值.方法 选择2013年5月~2016年1月于上海交通大学医学院附属同仁医院收治的ARVD患者81例为研究对象,根据心功能分为心功能Ⅱ级组(n=24)、心功能Ⅲ级组(n=30)和心功能Ⅳ级组(n=27),选择同期在我院体检的健康人群40例作为对照组.检测各组的BNP、Cys-c水平,左室射血分数(LVEF)及左室舒张末期内径(LVEDD).结果 将不同心功能分级的ARVD患者与对照组比较发现,其BNP、Cys-c、LVEF及LVEDD均存在显著差异(P＜0.05);ARVD患者随心功能降低,BNP、Cys-c水平及LVEDD呈升高趋势,而LVEF呈下降趋势,不同心功能的ARVD患者间差异显著(P＜0.05).多因素Logistic回归分析显示,BNP(OR=4.117)与Cys-c(OR=6.357)是ARVD患者心力衰竭的独立预测因子.BNP与Cys-c联合预测ARVD患者心力衰竭的ROC下AUC面积为0.905, 95%CI:0.839~0.971,其灵敏度与特异度均高于单项检测.随访18个月,以出现心力衰竭为终点结局,观察患者的生存率,BNP高危组(BNP≥731.43 ng/L)的生存曲线明显低于低危组(BNP＜731.43 ng/L), Cys-c高危组(Cys-c≥2.14 mg/L)生存曲线明显低于低危组(Cys-c＜2.14 mg/L),差异均具有统计学意义(P＜0.05).结论 BNP和Cys-c联合检测对ARVD引起的心力衰竭具有预测价值,可为临床预后评估提供参考.
Objective To discuss the value of brain natriuretic peptide (BNP) and serum cystatin C (Cys C) in predicting heart failure and prognosis review in patients with arrhythmogenic right ventricular dysplasia (ARVD). Methods ARVD patients (n=81) were chosen from Tongren Hospital affiliated to School of Medicine of Shanghai Jiao Tong University from May 2013 to Jan. 2016. All patients were divided, according to heart function, into cardiac grade Ⅱ group (n=24), cardiac grade Ⅲ group (n=30) and cardiac grade Ⅳ group (n=27), and meanwhile other health persons (n=40) received physical examination were chosen into control group. The levels of BNP and Cys-c, and left ventricular ejection fraction (LVEF) and left ventricular end-diastolic inner diameter (LVEDd) were detected in all groups. Results The difference in BNP, Cys-c, LVEF and LVEDd was significant in different cardiac grade groups compared with control group (P<0.05). As the decrease of heart function, levels of BNP and Cys-c and LVEDd showed an ascending trend, and LVEF showed a descending trend, and difference was significant among different cardiac grade groups (P<0.05). The results of multi-factor Logistic regression analysis showed that BNP (OR=4.117) and Cys-c (OR=6.357) were independent predictive factors for heart failure in ARVD patients. The combined prediction of BNP and Cys-c for heart failure showed that AUC of ROC was 0.905 (95%CI:0.839-0.971), and sensitivity and specificity of which were higher than those of single prediction of BNP or Cys-c. After followed patients up for 18 months, and heart failure was taken as endpoint outcome for observing survival rate, the survival curve was significantly lower in BNP high-risk group (BNP≥731.43 ng/L) than that in BNP low-risk group (BNP<731.43 ng/L), and was significantly lower in Cys-c high-risk group (Cys-c≥2.14 mg/L) than that in Cys-c low-risk group (Cys-c<2.14 mg/L, P<0.05). Conclusion The combined prediction of BNP and Cys-c has value for predicting heart failure induced by ARVD, which can provide reference for clinical prognosis review.