NT-proBNP、甘油三酯葡萄糖乘积指数联合超声心动图指标对老年心力衰竭的临床诊断价值

doi:10.3969/j.issn.1004-583X.2025.06.003

摘要/Abstract

摘要：

目的探讨N-末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、甘油三酯葡萄糖乘积(triglyceride-glucose,TyG)指数联合经胸超声心动图(transthoracic echocardiography,TTE)参数对老年心力衰竭(heart failure,HF)的联合诊断价值,并分析其独立影响因素。方法采用回顾性病例对照设计,纳入2024年2-12月本院收治的99例老年HF患者(观察组)及86例健康体检者(对照组),年龄60~90岁。收集两组基线资料、实验室检测指标及TTE参数,包括:NT-proBNP、甘油三酯、空腹血糖和左心室射血分数(left ventricular ejection fraction,LVEF)、左心房内径(left atrial diameter,LAD)、左室舒张末期内径等TTE指标。采用多因素logistic回归筛选HF独立影响因素,绘制受试者工作特征曲线评估各指标及联合模型的诊断效能。结果观察组糖尿病史(40.4% vs 10.5%)、冠心病史(90.9% vs 72.1%)、NT-proBNP(2825.00 vs 205.45 pg/ml)、TyG指数(8.68 vs 8.28)、甘油三酯(1.17 vs 0.97 mmol/L)、空腹血糖(6.29 vs 5.33 mmol/L)、左室舒张末期内径(50.10 vs 44.13 mm)、左心室收缩末期内径(36.30 vs 30.40 mm)、LAD(43.71 vs 35.94 mm)、左心室舒张末期容积(117.90 vs 102.0 ml)、左心室收缩末期容积(55.50 vs 36.55 ml)显著高于对照组(均P<0.05)。观察组LVEF(52.20% vs 63.80%)显著降低(P<0.05)。NT-proBNP(OR=1.000,95%CI: 1.000~1.001)、TyG指数(OR=12.711,95%CI: 4.034~40.047)及LAD(OR=1.143,95%CI: 1.053~1.241)为HF独立危险因素,LVEF(OR=0.929,95%CI: 0.881~0.980)为HF独立保护因素(均P<0.05)。联合模型(NT-proBNP+TyG+TTE)的AUC达0.932(95%CI: 0.899~0.966),高于单项指标(NT-proBNP:0.882;TyG:0749;TTE:0.868)及双指标组合(NT-proBNP+TTE:0.903)(均P<0.05),Hosmer-Lemeshow检验证实模型拟合良好(P>0.05)。结论 NT-proBNP、TyG指数与TTE参数联合应用对老年HF展现出良好的诊断效能,其中NT-proBNP、TyG指数、LAD增大及LVEF降低是HF的独立预测因子。

关键词: 心力衰竭, N-末端脑钠肽前体, 甘油三酯葡萄糖乘积指数, 经胸超声心动图

Abstract:

Objective To investigate the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and triglyceride-glucose (TyG) index combined with transthoracic echocardiography (TTE) parameters in elderly heart failure (HF), and to analyze their independent influencing factors. Methods A retrospective case-control study was conducted, including 99 elderly HF patients (observation group) and 86 healthy controls (control group) aged 60-90 years admitted from February to December 2024. Baseline data, laboratory indicators (NT-proBNP, triglycerides, fasting blood glucose), and TTE parameters (left ventricular ejection fraction [LVEF], left atrial diameter [LAD], left ventricular end-diastolic diameter [LVEDD], and others) were collected. Multivariate Logistic regression identified independent risk factors for HF, and receiver operating characteristic (ROC) curves evaluated the diagnostic performance of individual and combined models. Results The observation group showed significantly higher rates of diabetes (40.4% vs 10.5%), coronary heart disease (90.9% vs 72.1%), NT-proBNP (2825.00 vs 205.45 pg/ml), TyG index (8.68 vs 8.28), triglycerides (1.17 vs 0.97 mmol/L), fasting blood glucose (6.29 vs 5.33 mmol/L), LVEDD (50.10 vs 44.13 mm), left ventricular end-systolic diameter (36.30 vs 30.40 mm), LAD (43.71 vs 35.94 mm), left ventricular end-diastolic volume (117.90 vs 102.0 ml), and left ventricular end-systolic volume (55.50 vs 36.55 ml) compared to the control group (all P<0.05). LVEF was significantly lower in the observation group than in the control group (52.20% vs 63.80%, P<0.05). Multivariate analysis identified that NT-proBNP (OR=1.000, 95%CI: 1.000-1.001), TyG index (OR=12.711, 95%CI: 4.034-40.047), and LAD (OR=1.143, 95%CI: 1.053-1.241) were independent risk factors for HF, while LVEF (OR=0.929, 95%CI: 0.881-0.980) was an independent protective factor (all P<0.05). The combined model (NT-proBNP+TyG+TTE) achieved an area under the curve (AUC) of 0.932(95%CI: 0.899-0.966), surpassing that of an individual indicator (NT-proBNP: 0.882; TyG: 0.749; TTE: 0.868) and dual-indicator models (NT-proBNP+TTE: 0.903)(all P<0.05). Hosmer-Lemeshow test indicated good model fit (P>0.05). Conclusion The combination of NT-proBNP, TyG index, and TTE parameters demonstrates strong diagnostic efficacy for elderly HF. Elevated NT-proBNP, TyG index, increased LAD, and reduced LVEF are independent predictors of HF.

Key words: heart failure, N-terminal pro-B-type natriuretic peptide, triglyceride-glucose index, transthoracic echocardiography

中图分类号:

R541.62

曹丽卉, 霍祥辉. NT-proBNP、甘油三酯葡萄糖乘积指数联合超声心动图指标对老年心力衰竭的临床诊断价值[J]. 临床荟萃, 2025, 40(6): 498-503.

Cao Lihui, Huo Xianghui. Clinical diagnostic value of NT-proBNP and triglyceride-glucose index combined ith echocardiographic parameters in elderly patients with heart failure[J]. Clinical Focus, 2025, 40(6): 498-503.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.06.003

https://lchc.magtechjournal.com/CN/Y2025/V40/I6/498

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参考文献 21

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组别	例数		性别[例(%)]			年龄 (岁)		体重指数 (kg/m²)		高血压史 [例(%)]		糖尿病史 [例(%)]			冠心病史 [例(%)]
组别	例数		男	女		年龄 (岁)		体重指数 (kg/m²)		高血压史 [例(%)]		糖尿病史 [例(%)]			冠心病史 [例(%)]
对照组	86		45(52.3)	41(47.7)		72.50(67.00,79.00)		25.11±3.33		56(65.1)		9(10.5)			62(72.1)
观察组	99		49(49.5)	50(50.5)		74.00(71.00,81.00)		25.77±3.44		61(61.6)		40(40.4)			90(90.9)
统计值			χ²=0.148			Z=-1.935		t=-1.322		χ²=0.243		χ²=21.190			χ²=11.120
P值			0.701			0.053		0.188		0.649		<0.001			0.001
组别	NT-proBNP (pg/ml)				甘油三酯 (mmol/L)		空腹血糖 (mmol/L)		TyG指数		LVEF (%)			LVEDD (mm)
对照组	205.45(61.01, 498.28)				0.97(0.75, 1.28)		5.33(4.81, 5.88)		8.28(8.04, 8.63)		63.80(60.98, 66.80)			44.13(40.94, 46.75)
观察组	2825.00(958.00, 7997.00)				1.17(0.93, 1.46)		6.29(5.31, 8.72)		8.68(8.40, 9.18)		52.20(43.90, 61.50)			50.10(45.40, 57.10)
统计值	Z=-8.963				Z=-3.243		Z=-5.467		Z=-5.836		Z=-7.335			Z=-3.627
P值	<0.001				0.001		<0.001		<0.001		<0.001			<0.001
组别		LVESD(mm)			LAD(mm)		EDV(ml)			ESV(ml)			SV(ml)
对照组		30.40(28.23,32.03)			35.94±4.32		102.00(88.60,117.32)			36.55(30.53,41.60)			64.90(56.35,72.70)
观察组		36.30(31.00,43.40)			43.71±7.78		117.90(94.40,160.00)			55.50(39.10,84.90)			63.00(52.30,77.60)
统计值		Z=-5.892			t=-8.239		Z=-3.470			Z=-5.924			Z=-0.673
P值		<0.001			<0.001		<0.001			<0.001			0.502

组别	例数		性别[例(%)]			年龄 (岁)		体重指数 (kg/m²)		高血压史 [例(%)]		糖尿病史 [例(%)]			冠心病史 [例(%)]
组别	例数		男	女		年龄 (岁)		体重指数 (kg/m²)		高血压史 [例(%)]		糖尿病史 [例(%)]			冠心病史 [例(%)]
对照组	86		45(52.3)	41(47.7)		72.50(67.00,79.00)		25.11±3.33		56(65.1)		9(10.5)			62(72.1)
观察组	99		49(49.5)	50(50.5)		74.00(71.00,81.00)		25.77±3.44		61(61.6)		40(40.4)			90(90.9)
统计值			χ²=0.148			Z=-1.935		t=-1.322		χ²=0.243		χ²=21.190			χ²=11.120
P值			0.701			0.053		0.188		0.649		<0.001			0.001
组别	NT-proBNP (pg/ml)				甘油三酯 (mmol/L)		空腹血糖 (mmol/L)		TyG指数		LVEF (%)			LVEDD (mm)
对照组	205.45(61.01, 498.28)				0.97(0.75, 1.28)		5.33(4.81, 5.88)		8.28(8.04, 8.63)		63.80(60.98, 66.80)			44.13(40.94, 46.75)
观察组	2825.00(958.00, 7997.00)				1.17(0.93, 1.46)		6.29(5.31, 8.72)		8.68(8.40, 9.18)		52.20(43.90, 61.50)			50.10(45.40, 57.10)
统计值	Z=-8.963				Z=-3.243		Z=-5.467		Z=-5.836		Z=-7.335			Z=-3.627
P值	<0.001				0.001		<0.001		<0.001		<0.001			<0.001
组别		LVESD(mm)			LAD(mm)		EDV(ml)			ESV(ml)			SV(ml)
对照组		30.40(28.23,32.03)			35.94±4.32		102.00(88.60,117.32)			36.55(30.53,41.60)			64.90(56.35,72.70)
观察组		36.30(31.00,43.40)			43.71±7.78		117.90(94.40,160.00)			55.50(39.10,84.90)			63.00(52.30,77.60)
统计值		Z=-5.892			t=-8.239		Z=-3.470			Z=-5.924			Z=-0.673
P值		<0.001			<0.001		<0.001			<0.001			0.502

参数	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
参数	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
NT-proBNP	0.001	0.000	23.837	<0.001	1.001	1.000	1.001
TyG指数	2.026	0.387	27.396	<0.001	7.583	3.551	16.193
LVEF	-0.136	0.024	33.108	<0.001	0.873	0.834	0.914
LAD	0.222	0.036	38.283	<0.001	1.249	1.164	1.340

参数	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
参数	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
NT-proBNP	0.001	0.000	23.837	<0.001	1.001	1.000	1.001
TyG指数	2.026	0.387	27.396	<0.001	7.583	3.551	16.193
LVEF	-0.136	0.024	33.108	<0.001	0.873	0.834	0.914
LAD	0.222	0.036	38.283	<0.001	1.249	1.164	1.340

参数	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
参数	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
NT-proBNP	0.000	0.000	8.317	0.004	1.000	1.000	1.001
TyG指数	2.542	0.586	18.854	<0.001	12.711	4.034	40.047
LVEF	-0.074	0.027	7.273	0.007	0.929	0.881	0.980
LAD	0.134	0.042	10.201	0.001	1.143	1.053	1.241