BNP、Scr、S-100β蛋白及CysC对体外循环心脏手术患者预后的影响
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摘要
目的探讨脑钠肽(brain natriuretic peptide,BNP)、血清肌酐(serum creatinine,Scr)、S-100β蛋白及胱抑素C(cystatin C,CysC)对体外循环心脏手术预后的影响。方法选取2014年1月1日至2016年1月1日胸外科胸外科诊断为心力衰竭并接受体外循环(extracorporeal circulation,ECC)心脏手术的130例患者为研究对象,自出院后1周进行为期2年的随访。根据随访结果,将患者分预后良好组和预后不良组,运用Kaplan-Meier生存曲线分析体外循环心脏手术患者生存状态;单因素、多因素COX比例风险回归模型分析可能影响ECC心脏手术预后的因素;绘制ROC曲线比较各因素的敏感性及特异性。结果多因素COX比例风险回归模型分析显示S-100β(P=0.025)、Scr(P=0.015)、BNP(P=0.047)、CysC(P=0.008)、LVEF(P=0.037)可影响ECC心脏手术患者预后;CysC联合BNP的ACU为0.846,其敏感性、特异性分别为81.3%,79.05%。结论 S-100β、Scr、BNP、CysC,LVEF是ECC心脏手术预后的影响因素,CysC联合BNP诊断可作为ECC心脏手术的辅助预测指标,具有潜在临床应用价值。
Objective To explore the effects of brain natriuretic peptide(BNP),serum creatinine(Scr),S-100β protein and Cystatin C(CysC) on the prognosis of patients undergoing cardiopulmonary bypass.Methods A total of 130 patients with heart failure who received extracorporeal circulation(ECC) cardiac surgery in our hospital from January 1,2014 to January 1,2016 were enrolled in the study. These patients were followed up for two years after being discharged from hospital for a week.According to the follow up results,the patients were divided into good prognosis group and poor prognosis group.The survival state of patients was analyzed by Kaplan-Meier survival curve,and the sensitivity and specificity of different factors were analyzed and compared by single factor and multi factor COX proportional hazards regression model.Results The multi factor COX proportional hazards regression results showed that S-100β,Scr,BNP,CysC,LVEF might affect the prognosis of ECC patients undergoing cardiac surgery(P<0.05 or P<0.01).According to the ACU value of CysCcombined with BNP was 0.846,its sensitivity and specificity were 81.3%,79.05%,respectively.Conclusion S-100β,Scr,BNP,CysC and LVEF are the influencing factors of ECC cardiac surgery.CysC combined with BNP diagnosis can be regarded as an auxiliary predictive index for cardiac surgery,which has potential clinical application value.
Objective To explore the effects of brain natriuretic peptide(BNP),serum creatinine(Scr),S-100β protein and Cystatin C(CysC) on the prognosis of patients undergoing cardiopulmonary bypass.Methods A total of 130 patients with heart failure who received extracorporeal circulation(ECC) cardiac surgery in our hospital from January 1,2014 to January 1,2016 were enrolled in the study. These patients were followed up for two years after being discharged from hospital for a week.According to the follow up results,the patients were divided into good prognosis group and poor prognosis group.The survival state of patients was analyzed by Kaplan-Meier survival curve,and the sensitivity and specificity of different factors were analyzed and compared by single factor and multi factor COX proportional hazards regression model.Results The multi factor COX proportional hazards regression results showed that S-100β,Scr,BNP,CysC,LVEF might affect the prognosis of ECC patients undergoing cardiac surgery(P<0.05 or P<0.01).According to the ACU value of CysCcombined with BNP was 0.846,its sensitivity and specificity were 81.3%,79.05%,respectively.Conclusion S-100β,Scr,BNP,CysC and LVEF are the influencing factors of ECC cardiac surgery.CysC combined with BNP diagnosis can be regarded as an auxiliary predictive index for cardiac surgery,which has potential clinical application value.
引文
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6 Meyer JD,Hachimi-Idrissi S.S-100β in ruling out intracranial injury in pediatric mild traumatic brain injury:A metaanalysis.European Journal of Emergency Medicine,2017,24:e-2.
7 Bie P,Evans RG.Normotension,hypertension and body fluid regulation:brain and kidney.Acta Physiologica,2017,219:288-304.
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9 Merali Z,Leung J,Mikulis D,et al.Longitudinal Assessment of Imatinib’s Effect on the Blood-Brain Barrier After Ischemia/Reperfusion Injury with Permeability MRI.Translational Stroke Research,2015,6:39.
10 Donwauchope AC,Mckelvie RS.Evidence based application of BNP/NT-proBNP testing in heart failure.Clinical Biochemistry,2015,48:236-246.
11 Grossman E,Messerli FH.Hypertension and diabetes.Der Diabetologe,2015,11:371-372.
12 Vand MJ,Casselman F,Stockman B,et al.Endoscopic Port Access Surgery for Late Orthotopic Cardiac Transplantation Atrioventricular Valve Disease.Journal of Heart Valve Disease,2017,26:124-129.
13 Huynh K.Heart failure:Improvement of LVEF in patients with HF is linked to better prognosis.Nature Reviews Cardiology,2016,13:505.
14 Donwauchope AC,Mckelvie RS.Evidence based application of BNP/NT-proBNP testing in heart failure.Clinical Biochemistry,2015,48:236-246.
15 Zappitelli M,Greenberg JH,Coca SG,et al.Acute Kidney Injury Definition by Cystatin C Rise.Jama Pediatrics,2015,169.
16 Knapik P,Knapik M,Partyka R,et al.Utility of serum concentration of protein S100 at admission to the medical intensive care unit in prediction of permanent neurological injury.Kardiochirurgia I Torakochirurgia Polska=Polish Journal of Cardio-Thoracic Surgery,2016,13:347.
17 Kellum JA,Sileanu FE,Murugan R,et al.Classifying AKI by Urine Output versus Serum Creatinine Level.Journal of the American Society of Nephrology Jasn,2015,26:2231-2238.
18 WANG-Li.The Significance of Cys-C,UREA and Scr Tests in Early Renal Damage Assessment of Acute Glomerulonephritis.Labeled Immunoassays Clinical Medicine,2017,40:173-180.
19 Shultz B,Timek T,Davis AT,et al.Outcomes in patients undergoing complex cardiac repairs with cross clamp times over 300 minutes.Journal of Cardiothoracic Surgery,2016,11:1-8.
2 Zhang H,Zhang TY,Wang M,et al.Retrospective analysis of postoperative acute kidney injury in patients underwent open chest multivalvular replacement surgery.Chinese Journal of Extracorporeal Circulation,2017,31:415-422.
3 Schmid C.Extracorporeal Circulation and Myocardial Protection in Adult Cardiac Surgery.2017.
4 Jennett B,Glasgow GTF.Brain damage after cardiac surgery.Lancet,2015,1:1323.
5 Kleczyk R,Mysiak A,Brzostowicz P,et al.The dynamics of perioperative changes in serum BNP and troponin I concentrations in patients undergoing heart-valve correction with extracorporeal circulation.Resuscitation,2014,85:S106-S106.
6 Meyer JD,Hachimi-Idrissi S.S-100β in ruling out intracranial injury in pediatric mild traumatic brain injury:A metaanalysis.European Journal of Emergency Medicine,2017,24:e-2.
7 Bie P,Evans RG.Normotension,hypertension and body fluid regulation:brain and kidney.Acta Physiologica,2017,219:288-304.
8 Nandate K,Sharma D,Olivar H,et al.S-100β and Antioxidant Capacity in Cerebrospinal Fluid during and after Thoracic Endovascular Aortic Repair.International Scholarly Research Notices,2017,2017:1-4.
9 Merali Z,Leung J,Mikulis D,et al.Longitudinal Assessment of Imatinib’s Effect on the Blood-Brain Barrier After Ischemia/Reperfusion Injury with Permeability MRI.Translational Stroke Research,2015,6:39.
10 Donwauchope AC,Mckelvie RS.Evidence based application of BNP/NT-proBNP testing in heart failure.Clinical Biochemistry,2015,48:236-246.
11 Grossman E,Messerli FH.Hypertension and diabetes.Der Diabetologe,2015,11:371-372.
12 Vand MJ,Casselman F,Stockman B,et al.Endoscopic Port Access Surgery for Late Orthotopic Cardiac Transplantation Atrioventricular Valve Disease.Journal of Heart Valve Disease,2017,26:124-129.
13 Huynh K.Heart failure:Improvement of LVEF in patients with HF is linked to better prognosis.Nature Reviews Cardiology,2016,13:505.
14 Donwauchope AC,Mckelvie RS.Evidence based application of BNP/NT-proBNP testing in heart failure.Clinical Biochemistry,2015,48:236-246.
15 Zappitelli M,Greenberg JH,Coca SG,et al.Acute Kidney Injury Definition by Cystatin C Rise.Jama Pediatrics,2015,169.
16 Knapik P,Knapik M,Partyka R,et al.Utility of serum concentration of protein S100 at admission to the medical intensive care unit in prediction of permanent neurological injury.Kardiochirurgia I Torakochirurgia Polska=Polish Journal of Cardio-Thoracic Surgery,2016,13:347.
17 Kellum JA,Sileanu FE,Murugan R,et al.Classifying AKI by Urine Output versus Serum Creatinine Level.Journal of the American Society of Nephrology Jasn,2015,26:2231-2238.
18 WANG-Li.The Significance of Cys-C,UREA and Scr Tests in Early Renal Damage Assessment of Acute Glomerulonephritis.Labeled Immunoassays Clinical Medicine,2017,40:173-180.
19 Shultz B,Timek T,Davis AT,et al.Outcomes in patients undergoing complex cardiac repairs with cross clamp times over 300 minutes.Journal of Cardiothoracic Surgery,2016,11:1-8.