Repeated Measurements of NT-pro-B-Type Natriuretic Peptide, Troponin T or C-Reactive Protein Do Not Predict Future Allograft Rejection in Heart Transplant Recipients
Repeated Measurements of NT-pro-B-Type Natriuretic Peptide, Troponin T or C-Reactive Protein Do Not Predict Future Allograft Rejection in Heart Transplant Recipients
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DOI：
10.1097/tp.0000000000000378
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发表时间：
2015-03-01
期刊：
影响因子：
6.2
通讯作者：
Kardys, Isabella
中科院分区：
文献类型：
--
作者：
Battes, Linda C.;Caliskan, Kadir;Kardys, Isabella
背景关于一系列生物标志物检测对未来发生同种异体移植排斥反应（AR）的预后价值的研究很少。我们研究了重复测量NT-proBNP、TropT和CRP是否能预测AR。方法.从2005年到2010年，纳入了77例连续心脏移植（HTx）受者。在第一年随访期间，在连续16 +/- 4（平均值+/-标准差）次常规肌内膜活检监测访视时测量NT-proBNP、TropT和CRP。同种异体移植物排斥反应定义为国际心肺移植学会（ISHLT）在肌内膜活检中分级为2 R或更高。联合建模用于评估重复生物标志物测量与未来AR发生之间的关联。联合建模解释了个体患者重复观察之间的依赖性。结果HTx患者的平均年龄为49 ± 9.2岁，68%为男性。在第一年的随访中，获得了1，136份活检和同期血液样本，56名患者（73%）至少经历了一次AR发作。在有或没有AR的患者中，所有生物标志物在HTx后直接升高，并在约12周后达到稳态。NT-proBNP、TropT或CRP的重复测量与AR之间无相关性，（第0-12周）和晚期（第13-52周）在HTx后的过程中（第13-52周的风险比：每ln[单位]分别为0.96（95%置信区间，0.55-1.68）、0.67（0.27-1.69）和1.44（0.90-2.30））。在一个模型中组合三种生物标志物也呈现无效结果。结论AR前NT-proBNP、TropT和CRP的时间演变不能预测HTx后第一年早期和晚期急性AR的发生。
Background. Studies on the prognostic value of serial biomarker assays for future occurrence of allograft rejection (AR) are scarce. We examined whether repeated measurements of NT-pro-B-type natriuretic peptide (NT-proBNP), troponin T (TropT) and C-reactive protein (CRP) predict AR. Methods. From 2005 to 2010, 77 consecutive heart transplantation (HTx) recipients were included. The NT-proBNP, TropT, and CRP were measured at 16 +/- 4 (mean +/- standard deviation) consecutive routine endomyocardial biopsy surveillance visits during the first year of follow-up. Allograft rejection was defined as International Society for Heart and Lung Transplantation (ISHLT) grade 2R or higher at endomyocardial biopsy. Joint modeling was used to assess the association between repeated biomarker measurements and occurrence of future AR. Joint modeling accounts for dependence among repeated observations in individual patients. Results. The mean age of the patients at HTx was 49 +/- 9.2 years, and 68% were men. During the first year of follow-up, 1,136 biopsies and concurrent blood samples were obtained, and 56 patients (73%) experienced at least one episode of AR. All biomarkers were elevated directly after HTx and achieved steady-state after -12 weeks, both in patients with or without AR. No associations were present between the repeated measurements of NT-proBNP, TropT, or CRP and AR both early (weeks 0-12) and late (weeks 13-52) in the course after HTx (hazard ratios for weeks 13-52: 0.96 (95% confidence interval, 0.55-1.68), 0.67 (0.27-1.69), and 1.44 (0.90-2.30), respectively, per ln[unit]). Combining the three biomarkers in one model also rendered null results. Conclusion. The temporal evolution of NT-proBNP, TropT, and CRP before AR did not predict occurrence of acute AR both in the early and late course of the first year after HTx.