| 郝伟华,金颖,刘红娟,等.外周血尿素氮与肌酐比值联合前白蛋白水平对急性心力衰竭预后不良的预测价值[J].安徽医药,2024,28(5):934-938. |
| 外周血尿素氮与肌酐比值联合前白蛋白水平对急性心力衰竭预后不良的预测价值 |
| Prognostic value of the ratio of peripheral blood urea nitrogen to creatinine combined with prealbumin level for poor prognosis in patients with acute heart failure |
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| DOI：10.3969/j.issn.1009-6469.2024.05.018 |
| 中文关键词: 心力衰竭 尿素氮 肌酐 前白蛋白 预后不良 |
| 英文关键词: Heart failure Blood urea nitrogen Creatinine Prealbumin Poor prognosis |
| 基金项目: |
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| 中文摘要: |
| 目的分析外周血尿素氮与肌酐比值( BUN/Cr)联合前白蛋白( PA)水平对急性心力衰竭病人预后不良的预测价值。方法选取 2020年 7月至 2022年 1月石家庄市人民医院收治的急性心力衰竭病人 171例设为观察组，另选取同期在石家庄市人民医院体检的健康体检者 165例设为对照组，检测并计算两组的外周血 BUN/Cr和 PA水平。随访 6个月，根据病人是否因心力衰竭再次入院或死亡将观察组分为预后不良组和预后良好组，对比两组外周血 BUN/Cr和 PA水平。采用 logistic回归分析法分析急性心力衰竭病人预后不良的影响因素，另采用受试者操作特征(ROC)曲线分析外周血 BUN/Cr联合 PA水平对急性心力衰竭病人预后不良的预测价值。结果两组性别、年龄、身体质量指数( BMI)对比差异无统计学意义(P>0.05)，观察组的 BUN/ Cr(22.49±2.74)高于对照组( 14.79±2.88)差异有统计学意义( P<0.05)PA［(14.88±2.41)mg/dL］水平低于对照组［(30.32±5.84) mg/dL］，差异有统计学意义( P<0.05)；急性，心力衰竭病人预后不良的发，生率为 28.07%，预后不良组的美国纽约心脏病协会(NYHA)Ⅲ/Ⅳ级人数占比、 N末端 B型钠尿肽前体( NT-proBNP)水平、 C反应蛋白( CRP)水平、尿酸( UA)水平、 BUN/Cr［77.08%、(4325.37±863.07)ng/L、(12.55±2.41)mg/L、(517.82±103.04)μmol/L、(24.21±3.44)］均高于预后良好组［ 57.72%、(3411.59± 680.38)ng/L、(7.93±1.56)mg/L、(453.79±90.58)μmol/L、(21.82±2.06)］，差异有统计学意义( P<0.05)，左心室射血分数( LVEF)、 PA水平［( 37.82±7.04)%、(13.25±2.02)mg/dL］低于预后良好组［( 43.18±8.36)%、(15.51±2.26)mg/dL］差异有统计学意义( P< 0.05)； NYHAⅢ/Ⅳ级、 LVEF、NT-proBNP、CRP、UA、BUN/Cr、PA均是急性心力衰竭病人预后不良的影响因，素，差异有统计学意义( P<0.05)；外周血 BUN/Cr和 PA水平联合预测急性心力衰竭病人预后不良的灵敏度、特异度、曲线下面积( AUC)分别为 95.83%、78.86%、0.91，联合预测的灵敏度和 AUC均高于单独预测［ 75.00%、0.768；79.17%、0.80］差异有统计学意义( P<0.05)，特异度与单独预测［ 82.11%、80.49%］差异无统计学意义( P>0.05)。结论与健康人群相比，心力衰竭病人的 BUN/Cr升高、 PA降低，且 BUN/Cr、PA均为急性心力衰竭病人预后不良的影响因素，对预后不良的发生有一定的预测价值，该两项指标联急性， |
| 英文摘要: |
| Objective To analyze the predictive value of the ratio of peripheral blood urea nitrogen to creatinine (BUN/Cr) combinedwith prealbumin (PA) level for poor prognosis in patients with acute heart failure. Methods One hundred and seventy-one patientswith acute heart failure admitted to Shijiazhuang People′s Hospital from July 2020 to January 2022 were selected as the study group,and 165 healthy people who were examined in Shijiazhuang People′s Hospital at the same time were selected as the control group. Theperipheral blood BUN/Cr and PA level in the two groups were measured and calculated. Follow up for 6 months, the study group was as-signed into poor prognosis group and good prognosis group according to whether the patient was hospitalized again or died due to heartfailure, and the peripheral blood BUN/Cr and PA level of the two groups were compared. Logistic regression analysis was used to ana-lyze the influencing factors of poor prognosis in patients with acute heart failure, and the receiver operating characteristic (ROC) curvewas used to analyze the predictive value of peripheral blood BUN/Cr combined with PA level for poor prognosis in patients with acuteheart failure.Results There was no significant difference in gender, age and body mass index (BMI) between the two groups (P>0.05), and the BUN/Cr in the study group (22.49±2.74) was significantly higher than that in the control group (14.79±2.88) (P<0.05), and the PA [(14.88±2.41) mg/dL] level was significantly lower than that in the control group [(30.32±5.84) mg/dL] (P<0.05). The incidence rateof poor prognosis in patients with acute heart failure was 28.07%, and the proportion of New York Heart Association (NYHA) Ⅲ/Ⅳ, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, C-reactive protein (CRP) level, uric acid (UA) level, BUN/Cr in the poor prog-nosis group [77.08%, (4325.37±863.07) ng/L, (12.55±2.41) mg/L, (517.82±103.04) μmol/L, (24.21±3.44)] were significantly higherthan those in the good prognosis group [57.72%, (3411.59±680.38) ng/L, (7.93±1.56) mg/L, (453.79±90.58) μmol/L, (21.82±2.06)] (P< 0.05), while the left ventricular ejection fraction (LVEF) and PA level [(37.82±7.04)% , (13.25±2.02) mg/dL] were significantly lowerthan those in the good prognosis group [(43.18±8.36)% , (15.51±2.26) mg/dL] (P<0.05). NYHA III/IV, LVEF, NT-proBNP, CRP, UA,BUN/Cr and PA were all the influencing factors of the poor prognosis of patients with acute heart failure, and the difference were statis-tically significant (P<0.05). The sensitivity, specificity and area under the curve (AUC) of the combined prediction of peripheral bloodBUN/Cr and PA level for poor prognosis in patients with acute heart failure were 95.83%, 78.86% and 0.91, respectively, and the sensi-tivity and AUC of the combined prediction were significantly higher than those of the single prediction (75.00%, 0.768; 79.17%, 0.80)(P<0.05), but there was no significant difference in specificity between the combined prediction and the single prediction (82.11%,80.49%) (P>0.05).Conclusion Compared with healthy people, the BUN/Cr is higher and the levels of PA is lower in patients withacute heart failure, and BUN/Cr and PA are the influencing factors of poor prognosis in patients with acute heart failure, and they havecertain predictive value for the occurrence of poor prognosis, but the combined prediction of the two indexes is more valuable. |
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