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氨基末端脑利钠肽前体水平对糖尿病人群全因死亡的影响

The impact of N-terminal brain natriuretic peptide levels on all-cause mortality in diabetic population

    摘要
  • 摘要:
    目的 评估糖尿病患者的血清氨基末端脑利钠肽前体(NT-proBNP)水平，并分析其对糖尿病患者全因死亡的预测价值。
    方法 本队列研究对1999年—2004年全美健康和营养检查调查(NHANES) 中的18 065例患者资料进行了回顾性分析。参照美国糖尿病协会（ADA）标准进行糖尿病定义，即空腹血糖≥7.0 mmol/L、餐后血糖≥11.1 mmol/L、糖化血红蛋白≥6.5%或已确诊糖尿病；参照美国心脏病协会（AHA）最新心衰指南对人群的NT-proBNP界值标准，NT-proBNP≥125 pg/mL为心衰前期组、NT-proBNP＜125 pg/mL为非心衰组。通过Kaplan-Meier生存曲线分析两组的全因死亡情况。采用单因素及多因素Cox回归分析糖尿病患者全因死亡的影响因素。
    结果 在纳入的18 065例患者中，糖尿病患者占9.17%，心衰前期患者占17.17%，糖尿病患者中心衰前期占38.59%。NT-proBNP在糖尿病与非糖尿病人群中分别为80.71(33.71，232.7) pg/mL和38.13(18.41，79.55) pg/mL(P＜0.001)。NT-proBNP与糖化血红蛋白水平显著正相关(β=0.20, P＜0.001)。在糖尿病患者中采用Kaplan-Meier生存曲线分析显示，心衰前期组较非心衰组生存率显著降低：两组3年、5年和10年生存率分别为87.83%、78.76%、57.19%和97.46%、95.66%、89.73%(P＜0.001)。多因素Cox回归分析显示，NT-proBNP为糖尿病患者全因死亡的独立危险因素(P＜0.001)。
    结论 NT-proBNP在糖尿病患者中显著升高，且与全因死亡发生显著相关，可作为糖尿病管理的预后评估指标。

     

    Abstract:
    Objective To evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in diabetic patients as well as to analyze its predictive value for all-cause death in diabetic patients.
    Methods Clinical data of 18 065 patients in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004 were analyzed in this retrospective cohort study. The definition of diabetes was based on American Diabetes Association (ADA) criteria, which includes fasting blood glucose ≥7.0 mmol/L, postprandial blood glucose≥11.1 mmol/L, glycated hemoglobin≥6.5%, or confirmed diabetes. According to the latest American Heart Association (AHA) heart failure (HF) guidelines, the NT-proBNP cut-off value for the population was set at≥125 pg/mL for pre-HF group and < 125 pg/mL for non-HF group. Kaplan-Meier survival curve was used to analyze all-cause mortality in two groups. Single-factor and multi-factor Cox regression analyses were used to identify the factors affecting all-cause mortality in diabetic patients.
    Results Among the 18 065 patients, 9.17% had diabetes and 17.17% had pre-HF stages, of which 38.59% were in the pre-HF stages of diabetic patients. NT-proBNP levels in the diabetic and non-diabetic populations were 80.71 (33.71, 232.7) pg/mL and 38.13 (18.41, 79.55) pg/mL, respectively (P < 0.001). There was a significant positive correlation between NT-proBNP levels and glycated hemoglobin levels (β=0.20, P < 0.001). In diabetic patients, Kaplan-Meier survival curve analysis showed that the survival rate was significantly decreased in the pre-HF stages group, the survival rates for two groups at 3 years, 5 years, and 10 years were 87.83%, 78.76%, and 57.19%, and 97.46%, 95.66%, and 89.73%, respectively (P < 0.001). Multivariate Cox regression analysis showed that NT-proBNP was an independent risk factor for all-cause mortality in diabetic patients (P < 0.001).
    Conclusion NT-proBNP is significantly elevated in diabetic patients and is significantly associated with all-cause mortality. NT-proBNP can be used as a prognostic evaluation index for diabetes management.

     

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