腦鈉肽預測非心臟手術術后不良心血管事件發生的Meta分析_《中國循證醫學雜志》

作者：

張蓓 ,  王江 , 葉建榮

新疆醫科大學第一附屬醫院麻醉科（烏魯木齊 830054）;

關鍵詞：

腦鈉肽 N末端腦鈉肽原非心臟手術不良心血管事件 Meta分析系統評價隊列研究

DOI：

10.7507/1672-2531.20120226

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價腦鈉肽在預測非心臟手術術后發生不良心血管事件的有效性及準確性。
方法　計算機檢索The Cochrane Library 、PubMed、Ovid、EMbase、CBM、WanFang Data和CNKI，并手工檢索相關雜志以及納入文獻的參考文獻，檢索時限均為2000年至2011年。由2位評價者按照納入與排除標準獨立選擇相關隊列研究，提取資料和評價質量后，采用RevMan5.0軟件進行Meta分析。
結果　最終納入11個隊列研究，共3 649例患者。Meta分析結果顯示：術前腦鈉肽（BNP）水平高于節點的增高組患者術后不良心血管事件發生率高于術前BNP水平低于節點的非增高組患者，其差異有統計學意義［OR=27.54，95%CI（17.49，43.35），P lt;0.000 01］，而且N末端腦鈉肽原（NT-proBNP）的結果與BNP一致［OR=19.53，95%CI（13.54，28.17），P lt;0.000 01］。
結論　術前BNP和NT-proBNP檢測可用于預測非心臟手術患者術后發生心血管不良事件的風險。受納入研究質量限制，本研究結論尚需今后開展更多高質量的相關研究驗證。

引用本文： 張蓓,王江,葉建榮. 腦鈉肽預測非心臟手術術后不良心血管事件發生的Meta分析. 中國循證醫學雜志, 2012, 12(12): 1463-1469. doi: 10.7507/1672-2531.20120226 復制

1.	Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomized controlled trial. Lancet, 2008, 371(9627): 1839-1847.
2.	Weidemann A, Klanke B, Wagner M, et al. Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J, 2008, 409(1): 233-442.
3.	Alter P, Rupp H, Rominger MB, et al. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem, 2008, 314(1-2): 179-191.
4.	Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, 2006, 92(6): 843-849.
5.	Stroup DF, Brtlin JA, Morton SC, et al. Meta analysis of observational studies in epidemiology: a proposal for reporting. Meta analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
6.	Wells GA, Shea B, O’Connell D. Newcastle- Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
7.	Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
8.	Cuthbertson BH, Card G, Croal BL, et al. The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery. Anaesthesia, 2007, 62(9): 875-881.
9.	Cuthbertson BH, Amiri AR, Croal BL, et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth, 2007, 99(2): 170-176.
10.	Berry C, Kingsmore D, Gibson S, et al. Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart, 2006, 92(3): 401-402.
11.	Cardinale D, Colombo A, Sandri MT, et al. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation, 2007, 115(11): 1339-1344.
12.	Leibowitz D, Planer D, Rott D, et al. Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: A prospective study. Cardiology, 2007, 110 (4): 266-270.
13.	Goei D, Schouten O, Boersma E, et al. Influence of renal function on the usefulness of N-terminal pro-B-type natriuretic peptide as a prognostic cardiac risk marker in patients undergoing noncardiac vascular surgery. Am J Cardiol, 2008, 101 (1): 122-126.
14.	Feringa HH, Bax JJ, Elhendy A, et al. Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol, 2006, 98(1): 111-115.
15.	Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart, 2007, 93(2): 226-231.
16.	Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery: Brain natriuretic peptide in 1,590 patients. Heart, 2006, 92(11): 1645-1650.
17.	Yun KH, Jeong MH, Oh SK, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and periop erative cardiovascular risk in elderly patients. Circ J, 2008, 72(2): 195-199.
18.	Gibson SC, Payne CJ, Byrne DS, et al. B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery. Br J Surg, 2007, 94(7): 903-909.
19.	Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiacsurgery: A report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions,Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation, 2007, 116(17): e418-499.
20.	黃青青, 岳錦熙, 萬林駿, 等. 非心血管手術患者心臟危險性術前評估方法的比較. 中華麻醉學雜志, 2005, 25(10): 733-736.
21.	Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated with myocardial ischemia. FASEB J, 2003, 17(9): 1105-1107.
22.	Vanzetto G, Jacon P, Calizzano A, et al. N-terminal pro-brain natriuretic peptide predicts myocardial ischemia and is related to postischemic left-ventricular dysfunction in patients with stable coronary artery disease. J Nucl Cardiol, 2007, 14(6): 835-842.
23.	McDonagh TA, Robb SD, Murdoch DR, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet, 1998, 351(9095): 9 -13.
24.	Niizuma S, Iwanaga Y, Yahata T, et al. Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients. Nephrol Dial Transplant, 2009, 24(2): 597- 603.
25.	肖軍, 唐發寬, 華寧, 等. BNP與ACC/AHA指南評估老年非心臟手術心血管事件比較分析. 中國誤診學雜志, 2008, 8(11): 2521-2523.
26.	Gackowski A, Isnard R, Golmard JL, et al. Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J, 2004, 25(20): 1788-1796.
27.	Frangiskos I. Parthenakis, Alexandros P, et al. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. European Journal of Heart Failure, 2008, 10(5): 475-481.
28.	Galasko GI, Lahiri A, Barnes SC, et al, What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J, 2005, 26(21): 2269-2276.
29.	Raymond I, Groenning BA, Hildebrandt PR, et al. The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart, 2003, 89(7): 745-751.
30.	Redfield MM, Rodeheffer RJ, Jacobsen SJ, et al. Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol, 2002, 40(5): 976-982.
31.	沈洪兵. 循證醫學. 見: 姜慶五, 主編. 臨床流行病學. 第1版. 北京: 高等教育出版社, 2007: 240-250.

1. Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomized controlled trial. Lancet, 2008, 371(9627): 1839-1847.
2. Weidemann A, Klanke B, Wagner M, et al. Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J, 2008, 409(1): 233-442.
3. Alter P, Rupp H, Rominger MB, et al. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem, 2008, 314(1-2): 179-191.
4. Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, 2006, 92(6): 843-849.
5. Stroup DF, Brtlin JA, Morton SC, et al. Meta analysis of observational studies in epidemiology: a proposal for reporting. Meta analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
6. Wells GA, Shea B, O’Connell D. Newcastle- Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
7. Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
8. Cuthbertson BH, Card G, Croal BL, et al. The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery. Anaesthesia, 2007, 62(9): 875-881.
9. Cuthbertson BH, Amiri AR, Croal BL, et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth, 2007, 99(2): 170-176.
10. Berry C, Kingsmore D, Gibson S, et al. Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart, 2006, 92(3): 401-402.
11. Cardinale D, Colombo A, Sandri MT, et al. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation, 2007, 115(11): 1339-1344.
12. Leibowitz D, Planer D, Rott D, et al. Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: A prospective study. Cardiology, 2007, 110 (4): 266-270.
13. Goei D, Schouten O, Boersma E, et al. Influence of renal function on the usefulness of N-terminal pro-B-type natriuretic peptide as a prognostic cardiac risk marker in patients undergoing noncardiac vascular surgery. Am J Cardiol, 2008, 101 (1): 122-126.
14. Feringa HH, Bax JJ, Elhendy A, et al. Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol, 2006, 98(1): 111-115.
15. Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart, 2007, 93(2): 226-231.
16. Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery: Brain natriuretic peptide in 1,590 patients. Heart, 2006, 92(11): 1645-1650.
17. Yun KH, Jeong MH, Oh SK, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and periop erative cardiovascular risk in elderly patients. Circ J, 2008, 72(2): 195-199.
18. Gibson SC, Payne CJ, Byrne DS, et al. B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery. Br J Surg, 2007, 94(7): 903-909.
19. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiacsurgery: A report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions,Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation, 2007, 116(17): e418-499.
20. 黃青青, 岳錦熙, 萬林駿, 等. 非心血管手術患者心臟危險性術前評估方法的比較. 中華麻醉學雜志, 2005, 25(10): 733-736.
21. Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated with myocardial ischemia. FASEB J, 2003, 17(9): 1105-1107.
22. Vanzetto G, Jacon P, Calizzano A, et al. N-terminal pro-brain natriuretic peptide predicts myocardial ischemia and is related to postischemic left-ventricular dysfunction in patients with stable coronary artery disease. J Nucl Cardiol, 2007, 14(6): 835-842.
23. McDonagh TA, Robb SD, Murdoch DR, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet, 1998, 351(9095): 9 -13.
24. Niizuma S, Iwanaga Y, Yahata T, et al. Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients. Nephrol Dial Transplant, 2009, 24(2): 597- 603.
25. 肖軍, 唐發寬, 華寧, 等. BNP與ACC/AHA指南評估老年非心臟手術心血管事件比較分析. 中國誤診學雜志, 2008, 8(11): 2521-2523.
26. Gackowski A, Isnard R, Golmard JL, et al. Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J, 2004, 25(20): 1788-1796.
27. Frangiskos I. Parthenakis, Alexandros P, et al. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. European Journal of Heart Failure, 2008, 10(5): 475-481.
28. Galasko GI, Lahiri A, Barnes SC, et al, What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J, 2005, 26(21): 2269-2276.
29. Raymond I, Groenning BA, Hildebrandt PR, et al. The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart, 2003, 89(7): 745-751.
30. Redfield MM, Rodeheffer RJ, Jacobsen SJ, et al. Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol, 2002, 40(5): 976-982.
31. 沈洪兵. 循證醫學. 見: 姜慶五, 主編. 臨床流行病學. 第1版. 北京: 高等教育出版社, 2007: 240-250.

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腦鈉肽預測非心臟手術術后不良心血管事件發生的Meta分析

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《中國循證醫學雜志》

腦鈉肽預測非心臟手術術后不良心血管事件發生的Meta分析

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