文章摘要
冯淑娟,董存元,马海乾.NT-proBNP联合血清 HE4、25-(OH)-D检测对慢性肾脏病 200例发生急性心衰的预测价值[J].安徽医药,2024,28(7):1404-1409.
NT-proBNP联合血清 HE4、25-(OH)-D检测对慢性肾脏病 200例发生急性心衰的预测价值
Prediction value of NT-proBNP combined with serum HE4, 25-(OH)-D for acute heart failure in patients with chronic kidney disease
  
DOI:10.3969/j.issn.1009-6469.2024.07.029
中文关键词: 人附睾蛋白 4  心力衰竭  25羟基维生素 D  慢性肾脏病  预测价值
英文关键词: Human epididymal protein 4  Heart failure  25 hydroxyvitamin D  Chronic kidney disease  Predictive value
基金项目:河北省卫生健康委员会 2022年度医学科学研究课题项目( 20221899)
作者单位
冯淑娟 张家口市第一医院检验医学科河北张家口 075000 
董存元 张家口市第一医院检验医学科河北张家口 075000 
马海乾 张家口市第一医院检验医学科河北张家口 075000 
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中文摘要:
      目的检测慢性肾脏病( chronic kidney disease,CKD)合并急性心衰病人血清人附睾蛋白 4(human epididymal protein 4, HE4)25羟基维生素 D[25--D]水平变化,(N-terminal pro brain natriuretic peptide,NT-proB(OH) 探讨二者与 N-末端脑钠肽前体NP)联合、检测对 CKD病人发生急性心衰的预测价值。方法按随机数字表法选取 2021年 1月至 2022年 9月张家口市第一医院收治的 CKD病人 200例作为研究对象,根据病人住院期间是否发生急性心力衰竭,将病人分为心衰组 88例和非心衰组 112例。采用化学发光免疫分析法测定 HE4水平,酶联免疫吸附法测定 25--D水平,25(OH) 比较两组病人入院 24 h内 HE4、(OH) -D水平以及一般临床资料的差异; Pearson相关性分析 HE4、(OH) NT-proBNP与心功能指标、肾功能指标的相关性;受试者操作特征曲线( ROC曲线)分析 HE4、25--D、 25--D、 logistic回归分析 CKD病(OH) NT-proBNP对 CKD合并急性心衰病人的预测效能; 人发生急性心衰的影响因素。结果 CKD病人心衰组超敏 C反应蛋白( hs-CRP)[( 12.09±3.54)mg/L比( 8.76±2.17)mg/L]、 NT-proBNP[( 514.52±120.37)ng/L比( 396.38±77.25)ng/L]、 HE4[( 15.58±4.51)μg/L比( 11.39±3.33)μg/L]、左心室舒张末期内径(LVEDD)[( 62.87±10.25)mm比( 58.35±9.97)mm]、血肌酐[( 94.35±7.52)μmol/L比( 90.64±8.26)μmol/L]、尿素氮[( 3.54±0.42) mmol/L比(3.38±0.33)mmol/L]以及 24 h尿蛋白(2.13±0.66)g比25--D、[(1.53±0.42)g]水平显著高于非心衰组, (OH) 左心室射血分数( LVEF)水平显著低于非心衰组( P<0.05);经 Pearson法分析发现 HE4、NT-proBNP与 LVEDD呈正相关,与 LVEF呈负相关(r=0.32、-0.38,均 P<0.05)25-(OH)-D与 LVEDD呈负相关,与 LVEF呈正相关( r=-0.43、0.54,均 P<0.05)。 HE4(r=0.24、0.36、0.54,均P<0.05)、 NT-proBNr=0.53、0.35、0.51,均 P<0.05)与肌酐、尿素氮、 24 h尿蛋白呈正相关, 25-(OH)-D(r=-0.36、-0.43、 -0.45,均 P<0.05)与肌酐、尿素氮、 24 h呈负相关; logistic回归分析显示 HE4[OR 95%CI:2.10(1.27,3.48)]、 25-(OH)-D[OR 95%CI:1.32(1.03,1.68)]、 NT-proBNP[OR 95%CI:1.07(1.02,1.22)]、 LVEDD[OR 95%CI:2.31(1.48,3.61)]、 LVEF[OR 95%CI:P(1.21(1.06,1.39)]是 CKD病人发生急性心衰的影响因素( P<0.05); ROC曲线显示, HE4预测 CKD合并急性心衰病人的曲线下面积( AUC)为 0.82[95%CI:(0.76,0.88)]25-(OH)-D预测 CKD合并急性心衰病人的 AUC为 0.81[95%CI:(0.75,0.87)], NT-proBNP预测 CKD合并急性心衰病人的 AUC(0.66,]HE4、(OH) NT-proBNP三者联合预测 CKD为,0.74[95%CI:0.81), 25--D、 合并急性心衰病人的 AUC为 0.91[95%CI:(0.87,0.94)],大于 HE4、25-(OH)-D、NT-proBNP单独预测的 AUC值( Z三者联合 -HE4 =2.27、Z三者联合 -25(-OH)-D=2.72,Z三者联合 -NT-proBNP=3.98,P=0.011、=0.003、<0.001)。结论 HE4在 CKD合并急性心衰病人血清中表达上调, 25--D表达下调,是 CKD合并急性心衰发生的影响因素。
英文摘要:
      Objective To measure the changes of serum human epididymal protein 4 (HE4) and 25 hydroxyvitamin D [25-(OH)-D]levels in patients with chronic kidney disease (CKD) and acute heart failure, and to explore the predictive value of combined detectionof N-terminal pro brain natriuretic peptide (NT-proBNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in CKD patients with acute heart failure.Methods A total of 200 patients with CKD admitted to Zhangjiakou First Hospital from January 2021 to September 2022 were randomly selected as the study objects, and the patients were assigned into heart failure group (88 cases) and nonheart failure group (112 cases) according to whether acute heart failure occurred during hospitalization. HE4 level was measured bychemiluminescence immunoassay, the level of 25-(OH)-D was measured by ELISA, the differences in serum HE4, 25-(OH)-D and general clinical data between the two groups within 24 hours after admission were compared; Pearson correlation analysis was used to analyze the correlation between HE4, 25-(OH) -D, NT-proBNP and cardiac function indexes, renal function indexes. Receiver operating characteristic (ROC) curve was applied to analyze the predictive efficacy of HE4, 25-(OH)-D, and NT-proBNP in CKD patients withacute heart failure; Logistic regression analysis was used to analyze the influencing factors of acute heart failure in CKD patients.Re- sults The levels of Hs-CRP [(12.09±3.54) mg/L vs. (8.76±2.17) mg/L], NT-proBNP [(514.52±120.37) ng/L vs. (396.38±77.25) ng/L], HE4 [(15.58±4.51) μg/L vs. (11.39±3.33) μg/L], and Left ventricular end-diastolic diameter (LVEDD) [(62.87±10.25) mm vs. (58.35± 9.97) mm], Serum creatinine (SCr) [(94.35±7.52) μmol/L vs. (90.64±8.26) μmol/L], Urea nitrogen (BUN)[(3.54±0.42) mmol/Lvs. (3.38± 0.33) mmol/L] and 24 h urinary protein [(2.13±0.66) g vs. (1.53±0.42) g] in heart failure group were obviously higher than those in non heart failure group, while the levels of 25-(OH)-D and Left ventricular ejection fraction (LVEF) were obviously lower than those in non heart failure group (P<0.05); Pearson analysis showed that HE4 and NT-proBNP were positively correlated with LVEDD, and negatively correlated with LVEF (r=0.32, - 0.38, P<0.05), 25-(OH)-D was negatively correlated with LVEDD, and positively correlated with LVEF (r=-0.43, 0.54, P<0.05); HE4 (r=0.24, 0.36, 0.54, P<0.05), NT-proBNP (r=0.53, 0.35, 0.51, P<0.05) were positively correlated with SCr, BUN and 24 h urinary protein (P<0.05), 25-(OH)-D(r=-0.36, -0.43, -0.45, P<0.05) was negatively correlated with SCr, BUN and 24 h (P<0.05); Logistic regression analysis showed that HE4 [OR 95%CI:2.10 (1.27, 3.48)], 25-(OH)-D[OR 95%CI:1.32 (1.03, 1.68)], NT-proBNP [OR 95%CI:1.07 (1.02, 1.22)], LVEDD [OR 95%CI:2.31 (1.48, 3.61)] and LVEF [OR 95%CI:1.21 (1.06, 1.39)] were the influencing factors of acute heart failure in CKD patients (P<0.05). ROC curve showed that the Area under curve (AUC) of CKD patients with acute heart failure predicted by HE4 was 0.82 [95%CI: (0.76,0.88)], the AUC of CKD patients with acute heart failure predicted by 25-(OH)-D was 0.81 [95%CI: (0.75, 0.87)], the AUC of CKD patients with acute heart failure predicted by NT-proBNP was 0.74 [95%CI: (0.66, 0.81)], and the AUC of CKD patients with acute heart failure predicted by HE4, 25-(OH)-D combined with NTproBNP was 0.90 [95%CI:(0.87, 0.94)], which was greater than the AUC value predicted independently by HE4, 25-(OH)-D, and NTproBNP alone (Zcombination-HE4=2.27, Zcombination-25-(OH)-D=2.72, Zcombination-NT-proBNP=3.98,P=0.011,=0.003,<0.001).Conclusion The expression of HE4 is up-regulated and the expression of 25-(OH)-D is down-regulated in the serum of patients with acute heart failure in CKD, whichhas a good predictive value for acute heart failure in CKD and they are influential factors in the occurrence of acute heart failure inCKD.
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