Diabetes Care：NT-proBNP为老年糖尿病患者短期死亡强预测因子

　　一项新的研究指出，N末端脑钠肽前体（NT-proBNP）是老年2型糖尿病患者短期心血管死亡率的独立、强预测因子，无论患者既往是否合并心血管疾病。在NT-proBNP水平轻度上升的患者中此相关性显著。研究于2013年4月5日在线发表于《糖尿病护理》杂志。
　　本研究旨在探讨NT-proBNP是否为老年2型糖尿病患者全因死亡和心血管死亡的短期独立预测因子，并确立白蛋白排泄率（AER）和C反应蛋白（CRP）是否影响此关联性。
　　该前瞻性研究选取卡萨莱蒙费拉托人群研究中2型糖尿病患者队列，共纳入1825名2型糖尿病患者。在基线水平评估患者心血管风险因子，既往心血管疾病史和NT-proBNP水平，并评估5.5年时患者全因死亡以及心血管死亡率。应用多因素Cox比例风险模型评估死亡风险比（HRs）。
　　结果显示，随访期间发生390例死亡，其中175人死于心血管疾病。NT-proBNP四分位水平增加可显著增高死亡风险（P<0.001）。独立于心血管危险因素（CRP、AER），NT-proBNP >91pg/mL者全因死亡风险比为2.05（95%可信区间1.47-2.69），心血管死亡风险比4.47。NT-proBNP水平轻度上升患者，以及基线时无微量白蛋白尿和心血管疾病的患者，上述相关性非常显著（上四分位风险比分别为3.82 [95% CI 1.24–13.75]和3.14 [1.00–9.94]）。与白蛋白尿相比，NT-proBNP水平与死亡风险相关性更强，基线时存在微量白蛋白尿可使死亡风险叠加。
　　研究者指出，NT-proBNP与心血管死亡的相关性不受CRP的影响，而白蛋白排泄率（AER）则对其有叠加效应。
与糖尿病相关的拓展阅读：

• Invokana获准用于2型糖尿病
• 抑郁与1型糖尿病血糖控制不佳相关
• 抑郁与1型糖尿病血糖控制不佳相关
• Eur J Med Res：糖尿病患者需要口腔健康教育
• Diabetes Care：青少年期肥胖增高糖尿病风险 更多信息请点击：有关糖尿病更多资讯

NH2-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes
The Casale Monferrato population-based study
OBJECTIVE
To study whether NH2-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship.
RESEARCH DESIGN AND METHODS
The prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs).
RESULTS
During the follow-up period, 390 people died (175 for CVD) out of 9,101 person-years of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47–2.86) for all-cause and 4.47 (2.38–8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24–13.75]) and 3.14 [1.00–9.94]). Albuminuria and NT-proBNP had an additive effect on mortality, though the association was stronger for NT-proBNP.
CONCLUSIONS
NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.