A comparison of NT-proBNP and albuminuria for predicting cardiac events in patients with diabetes mellitus
A comparison of NT-proBNP and albuminuria for predicting cardiac events in patients with diabetes mellitus
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DOI：
10.1177/1741826711420015
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发表时间：
2012-10-01
影响因子：
8.3
通讯作者：
Pacher, Richard
中科院分区：
文献类型：
--
作者：
Clodi, Martin;Resl, Michael;Pacher, Richard
目的：心血管事件是糖尿病患者最相关的事件。我们旨在比较N末端脑钠素前体(NT-proBNP)和最新标记物白蛋白尿对糖尿病患者心脏事件的预测价值。方法：在这项前瞻性观察研究中，我们招募了1071名糖尿病患者。基线时测定NT-ProBNP和尿白蛋白--定义为尿白蛋白/肌酐比值和30 mg/g。患者在平均33.1个月的观察期内接受了随访。共有103名患者达到定义的终点(因心脏事件或死亡而计划外住院)。结果：糖尿病患者的平均病程为15+/-12年，糖化血红蛋白(1c)平均为7.5+/-3.1%。在基线时，23.7%的患者出现蛋白尿，36.6%的患者血浆NT-ProBNP水平为125pg/ml。包括年龄、性别、糖尿病病程、糖化血红蛋白(1c)、蛋白尿和InnNT-ProBNP在内的多项COX回归分析显示，InnNT-ProBNP(风险比2.314；95%CI 1.914-2.798，p<；0.001)比蛋白尿(HR 1.544；95%CI 1.007-2.368，p=0.047)或年龄(HR 1.030；95%可信区间1.008-1.053，p=0.007)。计算模型中有(A)蛋白尿、(B)NT-ProBNP或(C)两者的不同COX模型显示，当NT-ProBNP进入模型时，C指数最佳(C指数A 0.735，B 0.809，C 0.786)。Kaplan-Meier分析表明，如果NT-proBNP进入模型，蛋白尿不能增加实质性信息。结论：NT-proBNP预测心脏事件优于蛋白尿。
Aims: Cardiovascular events are the most relevant events in patients with diabetes mellitus. We aimed to compare the predictive values of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the state-of-the-art marker, albuminuria, for cardiac events in diabetic patients.Methods: In this prospective observational study we recruited 1071 patients with diabetes mellitus. NT-proBNP and albuminuria - defined as a urinary albumin/creatinine ratio >30 mg/g - were measured at baseline. Patients were followed during a mean observation period of 33.1 months. A total of 103 patients reached the defined endpoint (unplanned hospitalization due to a cardiac event or death).Results: The mean duration of diabetes was 15 +/- 12 years and the mean HbA(1c) was 7.5 +/- 3.1%. At baseline, 23.7% of the patients presented with albuminuria and 36.6% had plasma NT-proBNP values > 125 pg/ml. Multiple Cox regression analysis including age, gender, duration of diabetes HbA(1c), albuminuria, and lnNT-proBNP revealed that lnNT-proBNP (hazard ratio 2.314; 95% CI 1.914-2.798, p < 0.001) was a better predictor than albuminuria (HR 1.544; 95% CI 1.007-2.368, p = 0.047) or age (HR 1.030; 95% CI 1.008-1.053, p = 0.007). Calculating different Cox-models with (A) albuminuria, (B) NT-proBNP, or (C) both in the model revealed that the C-index was best if NT-proBNP was entered in the model (C-index for A 0.735, for B 0.809, and for C 0.786). Kaplan-Meier analysis demonstrated that albuminuria does not add substantial information if NT-proBNP is entered into the model.Conclusion: NT-proBNP was superior to albuminuria for predicting cardiac events.