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Injongo Ukuvavanya ukusebenza kokuxilongwa kwe-N-terminal B-uhlobo lwe-natriuretic peptide precursor (NT-proBNP) kwintlupheko yentliziyo, kunye nokuphuhlisa nokuqinisekisa isixhobo sokuxhasa isigqibo esidibanisa i-NT-proBNP yoxinaniso kunye neempawu zekliniki.
Kwenziwa izifundo ezili-14 ezivela kumazwe ali-13, kubandakanywa iimvavanyo ezilawulwa ngokungenamkhethe kunye nezifundo zoqwalaselo ezilindelekileyo.
Idatha yenqanaba lomthathi-nxaxheba ngamnye ukusuka kwi-10 ukuya kwi-369 yezigulane ezikrokreleka ukuba zingaphumeleli kwintliziyo ebuhlungu ziye zadityaniswa ukuze kuhlalutyelwe i-meta-analysis ukuqikelela ukunqunyulwa kwe-NT-proBNP.Isixhobo sokuxhasa isigqibo (i-Heart Failure Diagnosis kunye ne-Vavaluation Collaboration (CoDE-HF)), edibanisa i-NT-proBNP kunye neenguqu zeklinikhi ukunika ingxelo yokungaphumeleli kwentliziyo enzima kwizigulane ngamnye, iye yaphuhliswa kwaye yaqinisekiswa.
Iziphumo.Ngokubanzi, i-43.9% (4549 / 10 ~ 369) yezigulane zafunyaniswa ukuba zinesifo senhliziyo esibuhlungu (73.3% (2286 / 3119) kunye ne-29.0% (1802 / 6208) yezigulane kunye nangaphandle kokungaphumeleli kwentliziyo).isindululo sokunqunyulwa komda we-300 pg/mL sinexabiso elibi lokuqikelela i-94.6% (i-95% yexesha lokuzithemba, i-91.9% ukuya kuma-96.4%); ngaphandle kokusetyenziswa komgaqo othile weminyaka yobudala, ixabiso eliqikelelweyo lihluka kwi-61.0% (55.3% ukuya kwi-66.4%), i-73.5% (62.3% ukuya kwi-82.3%), kunye ne-80.2% (70.9% ukuya kwi-87.1%), kwizigulane ezineminyaka yobudala. <iminyaka engama-50, iminyaka engama-50-75, kwaye> iminyaka engama-75, ngokulandelanayo. ngaphandle kokusetyenziswa komgaqo-nkqubo weminyaka yobudala, ixabiso eliqikelelweyo lihluka kwi-61.0% (55.3% ukuya kwi-66.4%), i-73.5% (62.3% ukuya kwi-82.3%), kunye ne-80.2% (70.9% ukuya kwi-87.1%), kwizigulane. ubudala <iminyaka engama-50, iminyaka engama-50-75, kunye> neminyaka engama-75, ngokulandelelanayo. Несмотря на использование возрастных порогов правил, положительная прогностическая ценность варьировала ku 61,0% (от 55,3% 4до, 6, 8%, 8% (kusukela kwi-70,9% ukuya kwi-87,1%) у пациентов в возрасте <50 лет, 50-75 лет и >75 лет соответственно. Ngaphandle kokusetyenziswa kwemigangatho yobudala kwimithetho, ixabiso eliqikelelweyo elichanekileyo lihluka kwi-61.0% (ukusuka kwi-55.3% ukuya kwi-66.4%), i-73.5% (ukusuka kwi-62.3% ukuya kwi-82.3%) kunye ne-80.2% (ukusuka kwi-70.9% ukuya kwi-87.1%) kwizigulane. ubudala <iminyaka engama-50, iminyaka engama-50-75 kunye>>iminyaka engama-75, ngokulandelelanayo.Ngaphandle kokusetyenziswa kwemida yobudala kumgaqo, phakathi kwezigulane ezikhulileyo, amaxabiso aqikelelwayo ayengama-61.0% (uluhlu lwama-55.3 ukuya kuma-66.4%), ama-73.5% (uluhlu lwama-62.3 ukuya kuma-82.3%) kunye nama-80.2% (ukusuka kuma-70.9) Ipesenti ukuya kuma-87.1%).) utshintsho phakathi. <50 岁, 50-75 岁和>75 岁. <50岁,50-75岁和>75岁. <50 лет, 50-75 лет и >75 лет. <50 iminyaka, 50-75 iminyaka kunye> 75 iminyaka.Ukubonakaliswa kweklinikhi kwahluka kuninzi lwamacandelwana, ngakumbi kumaqela anokutyeba ngokugqithiseleyo, ukungasebenzi kakuhle kwezintso, okanye imbali yokungaphumeleli kwentliziyo.I-CoDE-HF yayilinganiswe kakuhle kwaye yayinocalucalulo oluhle kakhulu phakathi kwezigulane kunye nangaphandle kwembali yokungaphumeleli kwentliziyo (indawo ephantsi kwe-receiver curve 0.846 (0.830 ukuya kwi-0.862) kunye ne-0.925 (0.919 ukuya kwi-0.932), ngokulandelanayo, kunye ne-Brier score ye-0.130 kunye ne-0.130 kunye 0.099, ngokulandelanayo).).Kwizigulane ezingenayo ukuhluleka kwentliziyo kwangaphambili, ukuxilongwa kwakuhambelana kuwo onke ama-subgroups kunye nethuba eliphantsi le-40.3% (2502 / 6208) (ixabiso elibi lokuxela kwangaphambili i-98.6%, 97.8% ukuya kwi-99.1%) kunye ne-28.0% (1737 / 6208) amathuba okuba Ukungaphumeleli kwentliziyo ebukhali kwakuphezulu (ixabiso eliqikelelwayo eliqinisekileyo 75.0%, 65.7% ukuya kwi-82.5%).
Izigqibo Kuvandlakanyo lwentsebenziswano lwamazwe ngamazwe lwentsebenzo yokuxilonga ye-NT-proBNP, imiqobo ecetyiswayo kwizikhokelo zokufumanisa ukungaphumeleli kwentliziyo ebukhali yahluka ngokubanzi phakathi kwamaqela abalulekileyo ezigulane.Isixhobo seNkxaso yeSigqibo se-CoDE-HF sidibanisa i-NT-proBNP kwimilinganiselo eqhubekayo kunye nezinye iinguqu zeklinikhi, ukubonelela ngendlela ehambelanayo, echanekileyo kunye neyomntu.
Phantse i-1 yezigidi zabantu base-UK bahlupheke ngenxa yokungaphumeleli kwentliziyo kwaye ukuxhaphaka kulindeleke ukuba kunyuke malunga ne-50% kwiminyaka eyi-25 ezayo ngenxa yokuguga kwabantu.I-1 ye-acute heart failure ethotyiweyo ibalelwa kwi-5% yazo zonke izibhedlele ezingacetywanga.2 Ukuxilongwa ngokuchanekileyo kunye nexesha elifanelekileyo lokungaphumeleli kwentliziyo kunokuba ngumngeni, kwaye zombini izikhokelo zelizwe kunye namazwe ngamazwe zincoma ukuvavanywa kwe-peptides ye-natriuretic ukunceda ekuxilongweni.345678 Nangona ezi ngcebiso, ukuvavanywa kwe-N-terminal B-uhlobo lwe-natriuretic peptide precursor (NT-proBNP) ayizange yenziwe ngokuqhelekileyo, ngokuyinxenye ngenxa yokukhathazeka malunga noncedo lwayo lwekliniki kwihlabathi lenene.Uphononongo oluphanda ukusebenza koxilongo lwe-NT-proBNP luye lwaqhutywa ikakhulu kumaqela amancinci akhethiweyo ezigulane, nto leyo ethintela ukukwazi ukwenza ngokubanzi iziphumo kumacandelwana abalulekileyo eklinikhi, njengezigulana ezisele zikhulile kunye nezigulana ezinokusilela kwezintso okanye ukutyeba kakhulu, apho ezi mpawu ziyahluka. ngokuqinisekileyo.iya ixhaphake kakhulu kwizigulane ezinentliziyo.I-91011 ye-Statistical modeling approaches ezithathela ingqalelo iimpawu zesigulane ukubonelela ngoqikelelo lomntu siqu lunokuba nokusebenza okuhambelanayo kokuxilonga kuzo zonke iiseti zezigulane.12
Nangona iimodeli ezininzi ziye zaphuhliswa ukuqikelela i-prognosis kwizigulane ezinentliziyo engaphumeleliyo, imizekelo embalwa inokunceda ukuxilonga ukuhluleka kwentliziyo.13141516171819 Iinzame zangaphambili zineenzuzo ezininzi kodwa zibandakanya izinto eziguquguqukayo ezinokuthi zibenakho ukuvavanywa kwangaphambili koogqirha okanye iinkcazo zesigulana zeempawu.Ukongezelela, baquka i-NT-proBNP njengento eguquguqukayo yebhinari kwaye abazange bathathele ingqalelo ukusebenzisana okuguquguqukayo kunye nokungabikho komgca phakathi kwe-NT-proBNP kunye nezinye iinguqu zeklinikhi.Iinzame zangaphambili zokuphuhlisa nokuqinisekisa izikali zokuxilonga ziye zabandakanya inani elilinganiselweyo lezigulane ezisuka kwiziko elinye, elithintele ukuvavanywa kokusebenza kakuhle kumacandelo amancinci kunye nokunciphisa amathuba okwenziwa ngokubanzi kwangaphandle.
Kolu hlalutyo lubambiseneyo lwamazwe ngamazwe, siye savavanya ukusebenza kokuxilongwa kwezikhokelo 'ezicetyiswayo ze-NT-proBNP yemigangatho yokungaphumeleli kwentliziyo kwi-subset yezigulane.Emva koko, siphuhlise kwaye saqinisekisa isixhobo sokuxhasa isigqibo kwizigulane ezikrokreleka ukuba zingaphumeleli kwintliziyo esebenzisa imodeli yamanani ukudibanisa ukugxila kwe-NT-proBNP kunye neempawu zeklinikhi.
Senze uphononongo olucwangcisiweyo lokuchonga izifundo ezivavanya ukusebenza kokuxilonga kwe-NT-proBNP kwizigulana ezikrokreleka ukuba ziyoyisakala yintliziyo.Sihlaziye ukuhlaziywa kwangaphambili kukaRoberts et al1 ukubandakanya amagama angundoqo "ukungaphumeleli kwentliziyo" kunye "ne-peptides ye-natriuretic" ngokukhangela i-Embase, i-Medline, kunye neRejista ye-Cochrane ePhambili yezilingo eziLawulwayo zezihloko kunye nezicatshulwa ezipapashwe ngo-18 Agasti 2021 (Umbhalo owongezelelweyo 1) .Izifundo zazithathwa njengezifanelekileyo ukuba zidibene nale migaqo yokubandakanywa echazwe kwangaphambili: ukubhaliswa kwezigulane ezineminyaka eyi-≥18 iminyaka ekrokrelwayo yokusilela kwentliziyo kwimeko engxamisekileyo, umlinganiselo we-NT-proBNP kwiisampuli zegazi ezifunyenwe ngexesha lovavanyo lokuqala lwesigulane ngosuku lokwamkelwa, kunye nokuxilongwa kokusilela kwentliziyo okubukhali kwenziwa kusetyenziswa imigangatho eyamkelekileyo yereferensi.Abaphandi ababini (i-KKL kunye ne-MA) baphonononga ngokuzimeleyo zonke izifundo ezichongiweyo ngophando lweencwadi ezicwangcisiweyo, kwaye owesithathu (i-NLM) wenza isigqibo sokungqubuzana usebenzisa i-protocol echazwe ngaphambili (i-PROSPERO registry: CRD42019159407).
Sinxibelelane nababhali abafanelekileyo kuwo onke amaqela afanelekileyo ukuba acele ulwazi malunga nokugxilwa kwe-NT-proBNP, ukuxilongwa okuqinisekisiweyo kokusilela kwentliziyo, ukubalwa kwabantu (iminyaka yobudala, isini, ubuhlanga), imbali yangaphambili (ukungaphumeleli kwentliziyo, isifo se-coronary artery, inqanaba lesigulana esingaziwayo) .idatha ngesifo seswekile), uxinzelelo lwegazi, i-hyperlipidemia, ukutshaya, isifuba, isifo semiphunga esingapheliyo, isifo sezintso esinganyangekiyo), imilinganiselo yempilo (izinga lentliziyo kunye noxinzelelo lwegazi) kuvavanyo lokuqala, iimpawu zeklinikhi ze-hematological kunye ne-biochemical.Siye sajongana nabo bonke ababhali abafanelekileyo ukuchaneka, iinkcazo zezinto eziguquguqukayo, kunye nokugqibelela ngaphambi kwesivumelwano.Zonke izifundo zenziwa ngokuhambelana neSibhengezo saseHelsinki kwaye zavunywa ngokusesikweni ukuvumela ukwabelana ngedatha kwinqanaba lesigulane solu hlalutyo lwemeta.Abaphandi ababini (i-KKL kunye ne-MA) bavavanya ngokuzimeleyo umngcipheko we-bias kwisifundo ngasinye usebenzisa iSixhobo sokuHlola uMgangatho wokuHlola kwi-Diagnostic Acuracy, inguqulo ye-2 (QUADAS-2), kunye neengxabano ze-20 zasonjululwa ngumntu wesithathu (NLM).
Sifumene uqikelelo lwe-meta kunye ne-95% yexesha lokuzithemba kobuntununtunu, ukuchaneka, ixabiso elibi lokuxela kwangaphambili, kunye nexabiso eliqikelelwayo elincomekayo lesikhokelo esicetyiswayo se-NT-proBNP yolawulo lokuphuma komda (300 pg/mL) 58 kunye nobudala obukhethekileyo bomgaqo-kwimida ( I-450, i-900, kunye ne-1800 pg / mL yezigulane ezineminyaka <50, 50-75, kunye> iminyaka engama-75, ngokulandelanayo) 7 ngenxa yokungaphumeleli kwentliziyo ngokusebenzisa iindlela ezimbini, kunye noqikelelo olubalwe ngokwahlukileyo kwisifundo ngasinye kwaye luhlanganiswe kwizifundo. kwimodeli yeziphumo ezingaqhelekanga ze-binomial-eqhelekileyo kusetyenziswa indlela yeDerSimonian kunye neLaird.21 Siphinde savavanya ukusebenza kwale miqobo kumacandelwana axelwe kwangaphambili ahlulwe ngokweminyaka, isini, ubuhlanga, isalathisi sobunzima bomzimba, ukusebenza kwezintso, i-anemia, kunye nobukho bomzimba. iingxaki (ukungaphumeleli kwentliziyo kwangaphambili, uxinzelelo lwegazi, i-hyperlipidaemia, isifo seswekile, i-fibrillation ye-atrial, isifo esingapheliyo semiphunga). Мы получили метаоценки с 95% доверительными интервалами чувствительности, специфичности, отрицательной прогностической ценности и положительной прогностической ценности рекомендуемого порога исключения NT-proBNP (300 пг/мл)58 и возрастных порогов исключения ( 450, 900 и 1800 пг/мл для пациентов в возрасте < 50, 50-75 и >75 лет соответственно)7 для острой сердечной недостаточности с использованием двухэтапного подхода, при этом оценки рассчитываются отдельно в каждом исследовании, а затем объединяются по исследованиям.в модели биномиально-нормальных случайных эффектов с использованием метода ДерСимониана и Лэрда.21 Далее мы оценили эффективность этих пороговых значений в предварительно определенных подгруппах, стратифицированных по возрасту, полу, этнической принадлежности, индексу массы тела, функции почек, анемии и наличию сопутствующие заболевания (сердечная недостаточность в анамнезе, артериальная гипертензия, гиперлипидемия, сахарный диабет, мерцательная аритмия, хронибленская против правда.我们 对 指南 的 的 的 排除/ Ml) 7, 采用 阶段 阶段 阶段 项 研究 研究 中 计算 计算 估计值 中 汇总 在 二 二 二 二 二 二 二 二 二 随机 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些 这些阈值按年龄、性别、种族、体重指数、肾功能、贫血和存在合并症（既往心力衰竭、高血压、高脂血症、糖尿病、心房颤动、慢性阻塞性肺病）。我们 对 指南 的 的-procenp 排除 排除) 7 ， 采用 阶段 方法 ， 在 每 项 研究 中 分别 计算 估计值 然后 在 研究 中 汇总 在 使用 使用 使用 和 和 方法 二 项式 正态 随机 效应 中 。21 我们 评估 阈值 在 随机 效应 中。。。。 我们评估按 年龄 性别 、 种族 、 体重 指数 、 肾 功能 、 和 存在 合并症 （既往 心力 衰竭 、 高 血压 高脂血症 、 糖尿病 心 房 颤动 慢性 阻塞 性 肺病）。。。。使用 相同 方法 方法 了 了 了 浓度 浓度 浓度 浓度 范围 范围 性能 性能 性能 性能 性能 性能 性能 性能 性能 性能 最 最 最 最 的 的 具有 的 的 的 阴性 预测值 ≥ 预测值 预测值 ≥ ≥ 预测值 ≥ 预测值 预测值 预测值 ≥ ≥ 预测值 预测值 预测值 ≥ ≥ ≥ ≥ 预测值 ≥ 预测值 预测值 ≥ ≥ 预测值 ≥ 预测值 ≥ ≥ 预测值 ≥ 预测值 预测值 ≥ ≥ ≥ 预测值 预测值 预测值 ≥ 预测值 预测值 预测值 预测值 ≥ ≥ 预测值 预测值
Sibale ixabiso (i-0-100) ehambelana nethuba lokuphuhlisa ukungaphumeleli kwentliziyo kwisigulane ngasinye usebenzisa imodeli yamanani.Ngenxa yokwahluka okubonakalayo ekuxhaphakeni kwe-comorbidities kunye nokungaphumeleli kwentliziyo, siye saphuhlisa kwaye saqinisekisa iimodeli kwizigulane ezingenayo intliziyo, ngokulandelanayo.Sisebenzise ugxininiso lwe-NT-proBNP njengomlinganiselo oqhubekayo kwaye sakhetha iinjongo ezilula zeklinikhi eziguquguqukayo ezaziwa ukuba zinxulumene nokungaphumeleli kwentliziyo ebaluleke kakhulu ngexesha loqeqesho lomzekelo wethu (iminyaka yobudala, uqikelelo lwezinga lokuhluzwa kwe-glomerular, i-hemoglobin, imizimba yesalathiso sobunzima. )., izinga lentliziyo, uxinzelelo lwegazi, i-edema ye-peripheral, isifo esingapheliyo se-pulmonary obstructive nesifo senhliziyo ye-ischemic) (Isicatshulwa esongezelelweyo 2).
Ekuphuhliseni iKhowudi-HF, siye savavanya iimodeli ezine zamanani ahlukeneyo: Iimodeli ezixubeneyo zeMixed Linear, iNaive Bayes, iHlathi eliRandom, kunye ne-Extreme Gradient Boost (XGBoost) (Umbhalo owongezelelweyo 2).222324 Ukunika ingxelo ngedatha elahlekileyo kwizifundo (uMzobo owoNgezelelweyo A), saphinda-phinda iiseti zedatha ezili-10 sisebenzisa imodeli edibeneyo ye-multiple imputation kunye ne-randomized study-specific covariance matrix ehambelana ne-algorithm ye-Monte Carlo Markov chain.25 Senze imputation ezininzi kuzo zonke iinguqu ezibandakanyiweyo kwimodeli ngaphandle kwe-NT-proBNP.Senze ukuphindaphinda kwe-10 ye-10-fold-fold-validation yemodeli nganye kwaye sasebenzisa uqikelelo oluphakathi lwe-iteration kunye ne-datasets ezifakwe njenge-CoDE-HF yoqikelelo lwesigulane ngasinye.Emva koko, sichonge amanqaku achaza eyona nxalenye inkulu yezigulane ezinobungozi obuphezulu okanye obuphantsi bokungaphumeleli kwentliziyo, kunye nokusebenza kakuhle kokukhutshwa (i-75% yexabiso eliqikelelweyo elichanekileyo kunye ne-90% ekhethekileyo) kunye nokukhutshwa (i-98% yexabiso elibi kunye ne-90). % specificity) % ubuntununtunu) kwi-acute heart failure.
Sivavanye ukusebenza kwemodeli nganye kuluhlu lweemethrikhi zokuxilonga (indawo ephantsi kwegophe lokusebenza lommkeli, amanqaku eBrier, ubungakanani bezigulana ezifumana iikhrayitheriya ezinokwenzeka eziphezulu nezisezantsi, kunye namaxabiso aqikelelwayo aqinisekileyo kunye namacandelwana ezigulane).Inqaku leBrier lucalucalulo kunye nomlinganiselo wolungelelwaniso olubalwa ngokuthatha impazamo esemgangathweni phakathi kwezinto ezinokwenzeka eziqikelelweyo kunye nemigqaliselo.26 Sakhetha eyona modeli isebenzayo kwiKhowudi-HF isixhobo sokuxhasa isigqibo.Sivavanya ukusebenza kwe-CoDE-HF sisebenzisa uhlalutyo lwejika lesigqibo kunye nokuqinisekiswa kwangaphakathi nangaphandle.Ngamafutshane, le ndlela iphinda ihoye isifundo esinye ngexesha lokuqinisekiswa kwangaphandle kwaye isebenzisa izifundo eziseleyo ukuphuhlisa imodeli.27 Asizange singenise ixabiso kwiiseti zedatha eziqinisekisiweyo zangaphandle kwaye ngoko ke asizange siqinisekise ngaphandle kuninzi lwezifundo.Uguqulo lwalungekho ngokupheleleyo (uMzobo owoNgezelelweyo A).Sisebenzise i-R version 4.1.2 kulo lonke uhlalutyo.
Izigulane kunye namalungu ekhomishini yoluntu bathathe inxaxheba ekutolikeni kweziphumo.Kukho izicwangciso zokusasaza iziphumo kuluntu olufanelekileyo lwezigulane.
Saqhagamshelana nabaphandi abavela kwizifundo ezifanelekileyo ze-30, apho i-19 yaphendula.Izifundo ezilishumi elinesine (izifundo ze-12 ezilindelekileyo kunye nezilingo ezimbini ezilawulwa ngokungenamkhethe) zinike idatha yesigulane ngasinye kwi-10 ukuya kwi-369 izigulane ezikrokrelwayo zokungaphumeleli kwentliziyo (iminyaka eyi-69.3 ubudala; i-53.3% yamadoda) evela kumazwe e-13 (Itheyibhile 1).Umzobo B;IiTables ezongezelelweyo ze-A kunye ne-B) 1528293031323334353637383940 Zonke izifundo zenziwa kwisebe likaxakeka, ngaphandle kophononongo olulodwa olubandakanya izigulane ze-cardiac kunye ne-pulmonary (zithetha izigulane ze-488 kwisifundo ngasinye (i-quartile. Isithuba se-Bit 322-1053) .Ngokubanzi, i-43.9% (4549 / 10,369) yezigulane ziye zafumanisa ukuxilongwa okuqinisekisiweyo kokungaphumeleli kwentliziyo (i-median study prevalence 46% (31-54%)).Kwizigulane ezine-heart failure, iziganeko ze-heart failure ziphezulu kunezigulane ezingenayo intliziyo (73.3% (2286 / 3119) vs. 29.0% (1802 / 6208)) (I-Supplementary Table C).
Iimpawu ezisisiseko zezigulane ezihlulwe ngokuxilonga ukuhluleka kwentliziyo.Amaxabiso ngamanani (ipesenti) ngaphandle kokuba kuphawulwe ngenye indlela
Kwisikhokelo esicetyiswayo sokukhutshwa kwinqanaba le-300 pg / mL, uqikelelo lwe-meta oludibeneyo lwexabiso elibi lokuxela kwangaphambili, uvakalelo, ixabiso eliqikelelweyo eliqinisekileyo, kunye nokuchaneka kwe-NT-proBNP kuluntu jikelele yi-94.6% (i-95% yexesha lokuzithemba, i-91.9%) .ukuya kwi-96.4%), i-96.8% (ukusuka kwi-94.6% ukuya kwi-98.1%), i-62.9% (ukusuka kwi-51.3% ukuya kwi-73.3%) kunye ne-49.3% (ukusuka kwi-35.4 % ukuya kwi-63.4%) (i-Figure 1; iTheyibhile eyoNgezelelweyo D).Ngokubanzi, i-30.4% (3148 / 10,369) yezigulane zinezinga le-NT-proBNP ngaphantsi kwe-300 pg / mL.Nangona kunjalo, bekukho i-heterogeneity ephawulekayo phakathi kwamaqela angaphantsi kwezigulane kunye nezifundo (Umfanekiso 2; Umzobo 3; Izibalo ezongezelelweyo C kunye no-D).Amaxabiso aqikelelwayo angalunganga ayesezantsi kwizigulane ≥75 yeminyaka yobudala (88.2%, ukusuka kwi-83.5% ukuya kwi-91.8%), kunye nakwizigulana ezinembali yokusilela kwentliziyo (79.4%, ukusuka kwi-68.4% ukuya kwi-87.3%) kunye nokutyeba kakhulu. (90.4%, ukusuka kwi-84.5% ukuya kuma-87.3%).94.2%.
I-N-terminal threshold ye-pro-B-type natriuretic peptide (NT-proBNP) kwi-acute heart failure.Phezulu ekhohlo: Ixabiso elibi lokuxela kwangaphambili le-NT-proBNP yoxinaniso ukungabandakanyi ukuxilongwa kwentliziyo ebuhlungu.Emazantsi ekhohlo: Inani elongezelekayo labaguli abakrokreleka ukuba kukusilela kwentliziyo eqatha kunye noxinzelelo lwe-NT-proBNP ngaphantsi komqobo ngamnye.Phezulu ekunene: Ixabiso eliqikelelweyo le-NT-proBNP yoxinaniso lokuxilongwa kwentliziyo ebuhlungu.Ezantsi ekunene: Umlinganiselo owongezelekayo wezigulana ezikrokreleka ukuba ukusilela kwentliziyo eqatha kunye noxinzelelo lwe-NT-proBNP ngaphezulu komqobo ngamnye.
Ukusebenza kokuxilongwa kwezikhokelo-ezicetyiswayo ze-N-terminal thresholds ze-pro-B-type natriuretic peptide kumaqela angaphantsi kwesigulane: i-predictive value threshold ye-300 pg / mL.COPD = isifo esingapheliyo semiphunga;I-eGFR = uqikelelo lwezinga lokuhluza iglomerular
Ukusebenza kokuxilonga kwesikhokelo esicetyiswayo kwi-NT-proBNP kwimigangatho yamaqela ezigulane: ixabiso eliqikelelweyo eliqikelelweyo lemigangatho ethile yobudala kumaqela amancinci ezigulane (450, 900, kunye ne-1800 pg / mL <50, 50-75, kunye> iminyaka eyi-75, ngokulandelanayo). Ukusebenza kokuxilonga kwesikhokelo esicetyiswayo kwi-NT-proBNP kwimigangatho yamaqela ezigulane: ixabiso eliqikelelweyo eliqikelelweyo lemigangatho ethile yobudala kumaqela amancinci ezigulane (450, 900, kunye ne-1800 pg / mL <50, 50-75, kunye> iminyaka eyi-75, ngokulandelanayo). Диагностическая эффективность рекомендованных в руководстве порогов NT-proBNP для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл для <50, 50-75 и >75 лет соответственно). Ukusebenza kokuxilongwa kwesikhokelo-esicetyiswayo kwi-NT-proBNP yemigangatho yezigulane zezigulane: ixabiso eliqikelelwayo eliqikelelweyo lemigangatho ecacileyo yobudala kwi-subgroups yesigulane (450, 900, kunye ne-1800 pg / mL <50, 50-75, kunye> iminyaka eyi-75, ngokulandelanayo) .指南 推荐推荐 的 亚组 的 阈值 阈值 阈值 阈值 阈值 阈值 阈值 诊断 年龄 年龄 特异性 阈值 的 的 的 的阳性岁）.指南 推荐推荐 的 的 的 阈值阈值nP 阈值 阈值 阈值 阈值 的 年龄 年龄 年龄 特异性 的 的 的 的 的 的 的 的 的 特异性 Диагностическая эффективность порогов NT-proBNP, рекомендованных руководством, для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл, <50, 50-75 и >75 соответственно возрасту) . Ukusebenza koxilongo lwemigaqo-ecetyiswayo ye-NT-proBNP yemigangatho yezigulane: ixabiso eliqikelelweyo eliqikelelweyo lemigangatho ecacileyo yobudala kwizigulane ezincinci (450, 900, kunye ne-1800 pg / mL, <50, 50-75, kunye> 75, ngokulandelanayo kwiminyaka yobudala ).COPD = isifo esingapheliyo semiphunga;I-eGFR = uqikelelo lwezinga lokuhluza iglomerular
Uqikelelo lwe-meta oluhlanganisiweyo lwexabiso eliqikelelweyo leminyaka yobudala be-NT-proBNP 450, 900, kunye nomgaqo we-1800 pg / mL ngu-61.0% (55.3% ukuya kwi-66.4%), 73.5% (62.3% ukuya kwi-82). I-3%) kunye ne-80.2%, ngokulandelanayo (70.9% ukuya kwi-87.1%) (iThebhile 2).Iinkcukacha ezihambelanayo bezingama-87.8% (79.5% ukuya kuma-93.0%), 81.1% (72.6% ukuya kuma-87.5%), kunye nama-73.1% (65.2% ukuya kuma-79.8%).Ngokubanzi, i-48.7% (5052 / 10,369) yezigulane ezikrokreleka ukuba zingaphumeleli kwintliziyo ene-NT-proBNP ngaphezu kwale miqobo yobudala.Ngaphandle kwe-heterogeneity kuwo wonke amaqela eminyaka, ukusebenza kwezintso, kunye nokuxhaphaka kokungaphumeleli kwentliziyo, ngaphakathi kwamacandelwana, ukunqunyulwa kweminyaka yemithetho kwakunexabiso eliqikelelweyo eliqikelelweyo ngaphezulu kokunqunyulwa okukodwa kwe-300 pg/mL (Umfanekiso owongezelelweyo we-EI) .
Ukusebenza koxilongo lwe-N-terminal B-uhlobo lwe-natriuretic peptide precursor (NT-proBNP) umda weminyaka yokusilela kwentliziyo ebukhali
Lilonke, sichonge amaphononongo asixhenxe asemngciphekweni omkhulu wokuthatha icala (iTheyibhile eyoNgezelelweyo A).Kucazululo lovakalelo olukhawulelwe kwizifundo ezimfamekileyo kwi-NT-proBNP yogxininiso lokugweba ukusilela kwentliziyo kunye nezifundo ezinomngcipheko ophantsi wokuthambekela, iimpawu ezicetyiswayo zezikhokelo kunye nokunqunyulwa kweminyaka ye-NT-proBNP zahlala zingatshintshi (Iitheyibhile ezongezelelweyo E kunye no-F )..
I-100 pg/mL i-NT-proBNP threshold idibene neyona ndlela ingcono yokungabandakanyi kunye nexabiso elibi elibi elidityanisiweyo le-97.8% (uluhlu lwe-95.8% ukuya kwi-98.8%) kunye novakalelo lwe-99.3% (uluhlu lwe-98.5% ukuya kwi-99.7%) (iTheyibhile eyoNgezelelweyo D) .Nangona kunjalo, kuphela i-17.9% (i-1851 / 10 ~ 369) yezigulane zine-NT-proBNP yogxininiso ngaphantsi kwe-100 pg / mL, kwaye zazingalunganga kwizigulane ezisebekhulile kunye nezigulane ezinesifo senhliziyo, isifo se-coronary, kunye nembali yokuphazamiseka Izibikezelo zihlala zihlupheka. ..Ukusebenza kwezintso (Figure J).Ngokufanayo, i-1000 pg / mL ye-NT-proBNP yokunqunyulwa yadibana neendlela zethu zokuvavanya ezingcono kunye nexabiso eliqikelelweyo le-74.9% (64.4% ukuya kwi-83.2%) kunye ne-specific 76.1% (65.6% ukuya kwi-84.2%).ibisezantsi.Umahluko.Kwakhona kwakuphantsi kwi-subgroups yesigulane, ngakumbi abo bangenayo imbali yangaphambili yokungaphumeleli kwentliziyo (ixabiso eliqikelelwayo eliqinisekileyo 62%, 41% ukuya kwi-79%) (iThebhile eyoNgezelelweyo D; uMzobo owongezelelweyo K).
Imodeli yokunyusa i-gradient egqithisileyo (i-XGBoost) kunye nemodeli edibeneyo edibeneyo yomgca yayiyeyona modeli isebenzayo (indawo ephantsi kwegophe kwiqela loqeqesho elipheleleyo 0.925 (95% CI 0.919 ukuya ku-0.932) kunye ne-0.931 (0.925 ukuya kwi-0.937), ngokulandelanayo) (i-Supplement). Umbhalo 2).Nangona ukusebenza kwe-XGBoost kufana neemodeli ezixubeneyo eziqhelekileyo, eyona nto iphambili yeXGBoost kukukwazi ukubala amanqaku xa kukho amaxabiso angekhoyo.Olu luphawu olubalulekileyo esinethemba lokuluphumeza kwisixhobo sokuxhasa isigqibo se-CoDE-HF ukuququzelela ukuphunyezwa kwayo kwimisebenzi yeklinikhi, yingakho sikhethe imodeli ye-XGBoost njengomzekelo wokugqibela we-CoDE-HF.
I-CoDE-HF yayilinganiswe kakuhle kwaye yayinocalucalulo oluhle kakhulu kwizigulane kunye nangaphandle kokungaphumeleli kwentliziyo (indawo ephantsi kwe-curve yokusebenza ye-receiver 0.846 (0.830 ukuya kwi-0.862) kunye ne-0.925 (0.919 ukuya kwi-0.932) kunye ne-Brier score ye-0.130 kunye ne-0.130, ngokulandelanayo).0.099) (Umfanekiso 4; Umzobo owongezelelweyo. L).Amanqaku e-CoDE-HF ye-4.7 inika ixabiso elibi lokuxela kwangaphambili kwi-98.6% (97.8% ukuya kwi-99.1%) kunye novakalelo lwe-98.1% (96.9% ukuya kwi-98.9%) (i-Supplementary Table G), kunye nenqaku le-51.2 linika uqikelelo oluhle ixabiso.ixabiso le-75.0% (65.7%) 82.5%), i-speciality yi-92.2% (87.5% ukuya kwi-95.2%) yezigulane ezingenayo imbali yokungaphumeleli kwentliziyo.Ezi nqanaba ezibandakanyiweyo kunye nokukhutshwa zinentsebenzo efanayo yokuxilonga kuwo onke ama-subgroups (Umfanekiso 5, umzobo 6, umzobo 7). Ukuba la manqaku asetyenziswe kwizigulane ezikrokrelekayo ukuba zingaphumeleli kwintliziyo, i-CoDE-HF yayiza kuchonga i-40.3% (2502/6208) kumathuba aphantsi (<4.7) kunye ne-28.0% (1737/6208) kumathuba aphezulu (≥51.2) ukungaphumeleli kwentliziyo ebukhali. Ukuba la manqaku asetyenziswe kwizigulane ezikrokrelekayo ukuba zingaphumeleli kwintliziyo, i-CoDE-HF yayiza kuchonga i-40.3% (2502/6208) kumathuba aphantsi (<4.7) kunye ne-28.0% (1737/6208) kumathuba aphezulu (≥51.2) ukungaphumeleli kwentliziyo ebukhali. Если бы эти показатели применялись к пациентам с подозрением на острую сердечную недостаточность, CoDE-HF выявил бы 40,3% (2502/6208) при низкой вероятности (<4,7) и 28,0% (1737/6208) при высокой вероятности (≥51,2) сердечной недостаточности. Ukuba la mazinga asetyenziswe kwizigulane ezikrokrelwayo zokungaphumeleli kwentliziyo, i-CoDE-HF yayiza kubona i-40.3% (2502 / 6208) kunye namathuba aphantsi (<4.7) kunye ne-28.0% (1737 / 6208) kunye nentliziyo ephezulu (≥51.2) ukusilela.ukungaphumeleli kwentliziyo ebukhali.如果 将将 这些 应用 于 于 心力 心力 心力 的 的 患者 患者 将 将 出 出 出 出 出 出 出 出 出 出 出 出 出 出 出 出 出衰竭.如果 将 这些 这些 应用 于 急性 急性 心力 衰竭 衰竭 衰竭 识别 识别 识别 出 出 出 出 出 出 出 出 出) 急性 心力 心力 急性 急性 急性 急性 急性 急性 急性 急性 急性 . Если бы эти оценки применялись к пациентам с подозрением на острую сердечную недостаточность, CoDE-HF выявил бы 40,3% (2502/6208) низкой вероятности (<4,7) и 28,0% (1737/6208) высокой вероятности (≥ 51,2) острой сердечной недостаточности. Ukuba la manqaku asetyenziswe kwizigulane ezikrokrelwayo zokungaphumeleli kwentliziyo, i-CoDE-HF iya kubonisa i-40.3% (2502 / 6208) amathuba aphantsi (<4.7) kunye ne-28.0% (1737 / 6208) amathuba aphezulu (≥ 51.2) ukungaphumeleli kwentliziyo.ukudinwa.Phakathi kwezigulane ezinokusilela kwentliziyo esele zikhona, akukho nalinye lamanqaku kwiqela loqeqesho eliye ladibana neendlela zethu zokungabandakanywa ekujoliswe kuzo.Amanqaku e-CoDE-HF ayengama-84.5, ixabiso eliqikelelwayo eliqinisekileyo laliyi-92.7% (89.1% ukuya kuma-95.2%), kwaye ingcaciso yayiyi-90.2% (84.0% ukuya kwi-94.1%).Olu vavanyo luya kuchonga i-45.5% (1420 / 3119) yezigulane ezinethuba eliphezulu lokuphuhlisa ukungaphumeleli kwentliziyo (umzobo 8).Kucazululo lwegowuvu yesigqibo kuyo yonke into enokwenzeka, i-CoDE-HF yayinenzuzo ephezulu kune-NT-proBNP iyodwa (uMzobo owoNgezelelweyo M).Amanqaku e-CoDE-HF ancitshiswe kancinci ngaphandle kwembali yoqeqesho (indawo ephantsi kwe-receiver work curve yi-0.922 (0.916 ukuya kwi-0.929) kunye ne-0.841 (0.825 ukuya kwi-0.825 kwizigulane ezingenayo intliziyo kunye nokuhluleka kwentliziyo) 0.857).Ukuqinisekiswa kwangaphakathi nangaphandle kwesiphambano kuqhutywe kakuhle kwi-cohort yeemodeli zombini (uMzobo owongezelelweyo N).
I-Heart Failure Joint Diagnosis kunye ne-Evaluation Scale (i-CoDE-HF) ilinganiswe kumlinganiselo obonwayo wezigulane ezinentliziyo ebuhlungu.Umgca onamachaphaza ubonisa ulungelelwaniso olufanelekileyo.Inqaku ngalinye lihambelana nezigulane ze-100.Phezulu: Ukulinganisa kweCoDE-HF kwisigulane ngaphandle kokusilela kwentliziyo kwangaphambili.Ngezantsi: Ukulinganisa kwe-CoDE-HF kwisigulane esinembali yokuhluleka kwentliziyo.
Ukusebenza kokuxilongwa kweNtliziyo yokuSebenza kweNtliziyo kunye noVavanyo lweSikali (CoDE-HF) kumaqela angaphantsi kwezigulane.Inqaku lokukhutshwa kwe-CoDE-HF linexabiso elibi lokuxela kwangaphambili le-4.7 kwiqela lezigulane ezingenayo imbali yokungaphumeleli kwentliziyo.I-CoDE-HF isebenzisa i-N-terminal natriuretic peptide type B i-precursor concentrations njengemilinganiselo eqhubekayo kunye neenjongo ezilula ezichazwe kwangaphambili eziguquguqukayo (iminyaka yobudala, uqikelelo lwe-glomerular filtration rate (eGFR), i-hemoglobin, isalathisi sobunzima bomzimba, izinga lentliziyo, uxinzelelo lwegazi, i-peripheral edema, i-obstructive engapheliyo. isifo se-pulmonary (COPD) kunye nesifo senhliziyo) sibonelela ngovavanyo lomntu ngamnye malunga nokuxilongwa kwesifo senhliziyo esibuhlungu.
Ukusebenza kokuxilongwa kwesikali se-CoDE-HF kwiNtsebenziswano yokuHlola kunye noVavanyo lweNtliziyo yokuFaila isikali kumaqela amancinci ezigulane.Umgaqo we-CoDE-HF wawunexabiso eliqikelelweyo le-51.2 kwiqela lezigulane ezingenayo imbali yokungaphumeleli kwentliziyo.I-CoDE-HF idityaniselwe i-NT-proBNP yoxinaniso njengemilinganiselo eqhubekayo kunye neenjongo eziguquguqukayo ezilula ezichazwe kwangaphambili (ubudala, uqikelelo lwezinga lokuhluzwa kwe-glomerular (eGFR), i-hemoglobin, isalathisi sobunzima bomzimba, izinga lentliziyo, uxinzelelo lwegazi, i-peripheral edema, isifo esingapheliyo semiphunga (COPD) ).isifo se-coronary artery) ibonelela ngovavanyo lomntu ngamnye malunga nokuba nokwenzeka koxilongo lokungaphumeleli kwentliziyo
Ukusebenza kokuxilongwa kweNtsebenziswano yokuHlola kunye noVavanyo lweNtliziyo yeNtliziyo (i-CoDE-HF) isikali kwi-subgroups yesigulane.Inqaku lomgaqo we-CoDE-HF linexabiso eliqikelelweyo le-84.5 kwizigulane ezineembali zokungaphumeleli kwentliziyo kwiqela lezigulane.I-CoDE-HF idityaniselwe i-NT-proBNP yoxinaniso njengemilinganiselo eqhubekayo kunye neenjongo eziguquguqukayo ezilula ezichazwe kwangaphambili (ubudala, uqikelelo lwezinga lokuhluzwa kwe-glomerular (eGFR), i-hemoglobin, isalathisi sobunzima bomzimba, izinga lentliziyo, uxinzelelo lwegazi, i-peripheral edema, isifo esingapheliyo semiphunga (COPD) ).isifo se-coronary artery) ibonelela ngovavanyo lomntu ngamnye malunga nokuba nokwenzeka koxilongo lokungaphumeleli kwentliziyo
I-Heart Failure Joint Diagnosis kunye ne-Assessment Scale (CoDE-HF) ayisebenzi ngokuxilonga kwizigulane ezinembali yokungaphumeleli kwentliziyo.Phezulu: Amaxabiso aqikelelwayo angalunganga kunye aqinisekileyo kumanqaku eCoDE-HF.Umgca wamachaphaza oluhlaza okwesibhakabhaka othe nkqo ubonisa amanqaku ekujoliswe kuwo ayi-4.7.Umgca wamachaphaza obomvu othe nkqo ubonisa amanqaku omgaqo ekujoliswe kuwo angama-51.2.Ezantsi: imephu yoxinaniso lwamanqaku e-CoDE-HF kwizigulana ezingenambali yokungaphumeleli kwentliziyo.Ukungabikho kunye nokujoliswe kuko kwemigaqo kuchongiwe i-40.3% yezigulane ezinethuba eliphantsi kunye ne-28.0% enokwenzeka kakhulu, ngokulandelanayo.
Izigulane ezichongiweyo njengamathuba aphantsi yi-CoDE-HF ziye zanciphisa kakhulu zonke izizathu kunye nokufa kwe-CV kwiintsuku ze-30 kunye nonyaka we-1 kunezigulane ezichongiweyo njengeziphakathi kunye namathuba aphezulu (i-30-intsuku zonke-isizathu sokufa: 1. 0% xa kuthelekiswa ne-4.0 Ipesenti kunye ne-10.4%).Ukubhubha kwabo bonke oonobangela kunyaka omnye: 5.9% xa kuthelekiswa ne-17.8% kunye ne-33.4%, ngokulandelelanayo;Ukufa kweentsuku ze-30 kwizifo ze-cardiovascular: 0.2% vs. 0.8% kunye ne-4.1%;ukufa konyaka kwizifo ze-cardiovascular: 1.4% ngokubhekiselele kwi-3.4% kunye ne-16.3%, ngokulandelanayo) (umzobo 9). Kwizigulane ezine-NT-proBNP yoxinaniso <300 pg/mL xa kuthelekiswa nezo ≥300 pg/mL, zonke izizathu zokufa kweqondo lokufa zaziyi-0.8% xa zithelekiswa ne-7.6% kwiintsuku ze-30 kunye ne-5.9% xa zithelekiswa ne-26.6% ngonyaka omnye, ngokulandelanayo, kwaye izinga lokufa kwe-cardiovascular mortality laliyi-0.1% xa lithelekiswa ne-2.6% kwiintsuku ezingama-30 kunye ne-1.3% xa lithelekiswa ne-10.2% ngonyaka omnye, ngokulandelelana (itheyibhile eyongezelelweyo H; i-supplement figure O). Kwizigulane ezine-NT-proBNP yoxinaniso <300 pg/mL xa kuthelekiswa nezo ≥300 pg/mL, zonke izizathu zokufa kweqondo lokufa zaziyi-0.8% xa zithelekiswa ne-7.6% kwiintsuku ze-30 kunye ne-5.9% xa zithelekiswa ne-26.6% ngonyaka omnye, ngokulandelanayo, kwaye izinga lokufa kwe-cardiovascular mortality laliyi-0.1% xa lithelekiswa ne-2.6% kwiintsuku ezingama-30 kunye ne-1.3% xa lithelekiswa ne-10.2% ngonyaka omnye, ngokulandelelana (itheyibhile eyongezelelweyo H; i-supplement figure O). У пациентов с концентрацией NT-proBNP <300 пг/мл по сравнению с таковой ниже 300 пг/мл смертность от всех причин составила 5, 6 составила 5, 7 6% через один год, соответственно, и показатели смертности от сердечно-сосудистых заболеваний составили 0,1% по сравнению с 2,6% через 30 дней и 1,3% по сравнению с 10,2% через один год соответственно (дополнительная таблица H; дополнительный рисунок O). Kwizigulane ezine-concentration ye-NT-proBNP <300 pg / ml xa kuthelekiswa nangaphantsi kwe-300 pg / ml, yonke into yokufa yayiyi-0.8% xa kuthelekiswa ne-7.6% kwiintsuku ze-30 kunye ne-5.9% xa kuthelekiswa ne-26, i-6% ngonyaka omnye, ngokulandelanayo. , kunye namazinga okusweleka kweCV ayeyi-0.1% xa kuthelekiswa ne-2.6% kwiintsuku ezingama-30 kunye ne-1.3% xa ithelekiswa ne-10.2% ngonyaka omnye, ngokulandelelanayo (iTheyibhile eyoNgezelelweyo H; uMzobo owoNgezelelweyo O). NT-proBNP 浓度<300 pg/mL 的患者与≥300 pg/mL 的患者相比，30 天全因死亡率分别为0.8% ne-7.6% , 30 天全因死亡率在30 天时分别為0.1% 和2.6%，一年时分别為1.3% 和10.2%（补充表H；补充图O）。 NT-PROBNP 浓度 <300 pg/ml 的 与 ≥ ≥300 pg/ml 的 相比 ， 30 天全 因 分别 為心 i為 0.8% ne-7.6% . .血管 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 在 以及 以及 以及 以及 以及 在 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 在 以及 以及 以及 在 以及 以及 以及 以及 以及 在 以及 以及 以及 以及 在 以及 以及 在 以及 在 以及 以及 在 以及 以及 以及 在 以及 以及 在 以及 在 以及 以及）. Пациенты с концентрацией NT-proBNP <300 пг/мл по сравнению с ≥300 пг/мл имели 30-дневную смертность от всех причин, 6%, 6%, 6% года, а также сердечно-сосудистую смертность. Izigulane ezine-NT-proBNP i-concentrations <300 pg / mL xa kuthelekiswa ne-≥300 pg / mL ineentsuku ze-30 zokufa kwe-0.8% kunye ne-7.6%, ngokulandelanayo, i-5.9% kunye ne-26.6% kwiminyaka enye, kunye nokufa kwe-cardiovascular mortality.yayiyi-0.1% kunye ne-2.6% kwiintsuku ezingama-30 kunye ne-1.3% kunye ne-10.2% ngonyaka we-1 (iTheyibhile eyoNgezelelweyo H; uMzobo owoNgezelelweyo O).
Izinga lokusweleka kwemeko eyongezelekayo limiselwe yiNtsebenziswano yoFundo kunye noVavanyo lweNtliziyo eFailile (CoDE-HF) iqela elinokwenzeka
Senze i-meta-analysis yedatha yenqanaba lesigulane ngasinye ukuvavanya ukusebenza kokuxilonga kwe-NT-proBNP kwimiqobo kwizigulane ezingaphezu kwe-10 ezikrokrelekayo zokungaphumeleli kwentliziyo ezibandakanyiweyo kwizifundo ezilindelekileyo ze-14 ezivela kumazwe angama-13 esiye sayila kwaye saphunyezwa ngokusebenzisa i-NT-proBNP.IproBNP njengesixhobo sokuxhasa isigqibo somlinganiselo oqhubekayo.Sinika ingxelo ngeziphumo ezibalulekileyo eziliqela.Okokuqala, isikhokelo esicetyiswayo semigangatho yokungabandakanyi ukungaphumeleli kwentliziyo ebukhali ayifani kuwo onke amacandelwana abalulekileyo ezigulane.I-3 Nangona inani labantu ngokubanzi kunye namacandelwana amaninzi, kubandakanywa izigulane ezincinci kunye nabasetyhini, baqhube kakuhle, izigulane ezikhulileyo kunye nabasetyhini babenemilinganiselo ephantsi kakhulu yokuxela kwangaphambili.Kwizigulane ezinokutyeba kakhulu okanye ukungaphumeleli kwentliziyo kwangaphambili, izinga lobuxoki elibi lisuka kwesinye kwishumi ukuya kwesinye kwisihlanu.Okwesibini, imida yeminyaka yobudala iye yazibonakalisa kakuhle ekuxilongweni kokusilela kwentliziyo.Nangona kunjalo, ixabiso elihle lokuxela kwangaphambili laliphantsi kwizigulane ezincinci.Okwesithathu, nangona i-NT-proBNP yethu ephuculweyo ye-100 pg / mL ukulawula ukungaphumeleli kwentliziyo kunye ne-1000 pg / mL ukulawula ukungaphumeleli kwentliziyo kunexabiso elihle kakhulu elibi kunye nexabiso elihle lokuxela kwangaphambili kubemi ngokubanzi, izigulane ezindala zibi kakhulu. .kwizigulane ezinentliziyo ebuhlungu.Ukungaphumeleli kwentliziyo kwangaphambili kunye nokutyeba.Ekugqibeleni, siye saphuhlisa kwaye saqinisekisa isixhobo sokuxhasa isigqibo, inqaku le-CoDE-HF, kunye nokusebenza okugqwesileyo kokuxilonga kuwo onke amacandelwana ezigulane.Esi sixhobo senkxaso yesigqibo asibandakanyi kwaye silawula ukungaphumeleli kwentliziyo ebukhali ngokuchanekileyo kunanoma yiyiphi indlela esebenzisa kuphela i-NT-proBNP threshold.
Kulwazi lwethu, olu lolona phando lukhulu ukuza kuthi ga ngoku luvavanya ukusebenza kokuxilonga kwe-NT-proBNP kwintliziyo ebuhlungu.Zonke izifundo ezibandakanyiweyo zazilindelekile kwaye uxilongo lokugqibela lwenziwa liqela leekliniki lisebenzisa lonke ulwazi olukhoyo.Kubalulekile ukuqaphela ukuba ukufumaneka kwedatha kwinqanaba lesigulane somntu ngamnye kwinani elikhulu lokufunda livumela uvavanyo oluthembekileyo lwentsebenzo yokuxilonga yonke imigangatho ye-NT-proBNP enokwenzeka kumaqela amancinci ezigulane, kunye nophuhliso kunye nokuqinisekiswa kwezikali ezintsha zokuxilonga.
Uninzi lwezikhokelo zelizwe kunye nezamazwe ngamazwe zincoma ukusebenzisa ixabiso le-NT-proBNP lokunqunyulwa kwe-300 pg / mL ukulawula ukungaphumeleli kwentliziyo ebukhali58 ngokusekelwe kwizifundo ezininzi zangaphambili344142 ezixela ixabiso elibi lokuxela kwangaphambili le-98% kule nxalenye yokunqunyulwa.ukusebenza kokuxilonga kwamacandelwana abalulekileyo ezigulane akukwazanga ukuhlolwa.Uphononongo lwethu lubhalise ngokuphindwe kathathu izigulane ezininzi njengohlalutyo lwe-meta-level yophando lwangaphambili, i-3 ebonise ixabiso eliphantsi elibi elibi lokuqikelela kwi-cut-off ye-300 pg / mL kunye noqikelelo lwe-meta oludibeneyo lwe-94.6%.Okubaluleke ngakumbi, ixabiso elibi lokuxela kwangaphambili laliphantsi kakhulu kumacandelo abalulekileyo afana nezigulana ezisele zikhulile kunye nezigulane ezinentliziyo ekhoyo ngaphambili, isifo se-coronary artery, kunye nokukhuluphala.Ukongezelela, phantse i-70% yezigulane zine-NT-proBNP yogxininiso ngaphezu kwe-300 pg / ml ye-cut-off point, egxininisa imida yokusebenzisa indawo enye yokusika ekusebenzeni.Nangona i-cutoff ephantsi ye-100 pg / mL ifezekise ixabiso elibi elibi lokuqikelela i-98%, lenze kakubi kwiqela elibalulekileyo lezigulane.Ukongeza, ubudala kunye nemigangatho ephuculweyo yokungaphumeleli kwentliziyo ebukhali ibonise i-heterogeneity kuwo wonke ama-subgroups ezigulane, ngakumbi phakathi kwabo bangenayo imbali yangaphambili yokungaphumeleli kwentliziyo.Oku kungafaniyo ekusebenzeni kokuxilonga kuyinkxalabo ekhethekileyo njengoko iminyaka yethu yezigulane kwaye ineengxaki ezininzi.Oku kuphakamisa umbuzo wokuba ngaba izikhokelo zeklinikhi kufuneka ziqhubeke zincoma ukusetyenziswa kwe-uniform cut-offs xa i-NT-proBNP ichaphazeleka kwizinto ezininzi ezinobungozi kunye ne-comorbidities.
Ukuphucula ukusetyenziswa kweklinikhi ye-NT-proBNP, siphuhlise kwaye saqinisekisa ngaphandle kovavanyo lwe-CoDE-HF yesixhobo sokuxhasa isigqibo seklinikhi.Eli nqaku lidibanisa i-NT-proBNP njengomlinganiselo oqhubekayo kunye neenjongo ezilula eziguquguqukayo zeklinikhi ukubonelela ngovavanyo lomntu ngamnye malunga nokuxilongwa kwentliziyo ebuhlungu.Sibonisa ukuba ukusebenza kokuxilonga kwamanqaku e-CoDE-HF kunamandla kumaqela amancinci ezigulane.I-CoDE-HF yakwazi ukukhupha kwaye ikhuphe ukuxilongwa kwesifo senhliziyo esibuhlungu kwisixa esikhulu sezigulane kunomda we-NT-proBNP olungiselelwe yedwa.Ngaphaya koko, kuhlalutyo lwethu lwegophe lesigqibo, sifumanise ukuba i-CoDE-HF inenzuzo ephezulu kune-NT-proBNP iyodwa, kulo lonke uluhlu olunokwenzeka.Sikholelwa ukuba esi sigqibo sinengqondo kuba i-NT-proBNP ngummakishi oqhubekayo womngcipheko kwaye ukugxininiswa kwayo kuxhomekeke kwezinye izinto ezinxulumene nesigulane ezifana nesalathisi sobunzima bomzimba, ubudala, kunye nomsebenzi wezintso.434445 Nangona ezi zilinganiso zisekelwe kwiikhrayitheriya zokusebenza ezichazwe kwangaphambili, siyaqonda ukuba ezi njongo azinakuxhaswa jikelele kwaye izibonelelo zempilo ezahlukeneyo zinokuba nokunyamezela komngcipheko okwahlukileyo.Inzuzo yokusebenzisa izixhobo zokuxhasa izigqibo ezifana ne-CoDE-HF kukuba oogqirha okanye amaziko anokukhetha imigaqo yokusebenza yokuxilonga ukuba isetyenziswe kwisigqibo sendawo esekelwe kwizinto eziphambili kunye nokufumaneka kwe-echocardiography okanye iingcali zokuhluleka kwentliziyo..
Silindele ukuba isixhobo sethu esitsha sokuxhasa isigqibo, iKhowudi-HF, inokuphucula ukuvavanywa kwezigulana ezikrokreleka ukuba ziyokungaphumeleli kwentliziyo ebonwa kwiingcali ezahlukeneyo zonyango kunye nokuguqula ukhathalelo lwabo, kube lula ukuxilongwa ngokuchanekileyo.Uphononongo lwangaphambili lubonise ukuba unyango olusekwe ngexesha kunye noluchanekileyo olusekelwe kubungqina bezigulane ezineentliziyo ezibuhlungu zinganciphisa kakhulu ukufa kunye nobude besibhedlele, kwaye ukulibaziseka kuhambelana neziphumo ezimbi.I-46 Ukongezelela, i-CoDE-HF eqokelelwa rhoqo isebenzisa izinto eziguquguqukayo kwaye ngoko ke inokufakwa kwi-workflows yeklinikhi njengenxalenye yendlela yokuvavanya isebe eliphuthumayo ukwenzela ukuba uvavanyo lusebenze ngakumbi.Okwangoku, uninzi lwezigulana ezikrokreleka ukuba ziyohluleka kwintliziyo ebukhali zine-echocardiography ekumkelwe kuyo ukuze zichonge unyango lwazo, kodwa kuphela iseti encinci yezigulana eziye zafunyaniswa ekugqibeleni.2 I-Echocardiography luphononongo oluthatha ixesha nolusebenzisa kakhulu izixhobo Silindele ukuba ukusetyenziswa kwe-CoDE-HF kusetyenziso oluchaneke ngakumbi nolunolwazi lweenkonzo ezizodwa ezifana ne-echocardiography kunokukhokelela ekongeni kweendleko kunye nokusebenza kakuhle kwenkqubo yokhathalelo lwempilo..Ukongezelela, ukugcinwa kweendleko kunokufezekiswa ngonyango lwezigulane ezingaphandle kwezigulane ezinobungozi obuphantsi.Uphononongo olulindelekileyo okwangoku luyafuneka ukuvavanya iklinikhi kunye neendleko-zokusebenza kwezigqibo ezahlukeneyo ze-CoDE-HF kwizenzo zeklinikhi.
Siyayivuma imida emininzi.Okokuqala, sakwazi ukufumana idatha yenqanaba lesigulane ngasinye kwi-14 yezifundo ze-30 eziye zadibana neendlela zethu zokufaneleka, ngoko ke ukhetho olukhethiweyo lunokwaziswa.Nangona kunjalo, izifundo ezifanelekileyo ezingazange zibandakanywe zineemeko ezifanayo zokungaphumeleli kwentliziyo, imihla yokupapashwa, kunye neendawo zokuhlala, kwaye abantu babeneempawu ezifanayo zedemografi kunye nekliniki kubantu ababandakanyiweyo.Okwesibini, xa ulwazi oluvela kwizifundo ezininzi ludityanisiwe, ezinye izifundo zazingekho idatha kwezinye izinto eziguquguqukayo.Ukwandisa ukusetyenziswa kolwazi, sasebenzisa indlela ye-hierarchical yokulinganisa ezininzi.Okwesithathu, asizange sirekhode idatha ye-ECG kunye nesifuba se-X-ray ngokulandelelana ukuze sibabandakanye kwimodeli yethu.Ukutolikwa kwe-NT-proBNP kwizigulana ezikrokrelekayo ukuba zingaphumeleli kwintliziyo kufuneka zenziwe ngokubambisana nezi zifundo, i-47 kunye nezifundo ezongezelelweyo ziyafuneka ukuze kuqinisekiswe ukuba iindlela zokudibanisa ezi zifundo zinokuphucula amanqaku e-CoDE-HF.Okwesine, ayizizo zonke izifundo ezenza uxilongo ngaphandle kokuthathela ingqalelo iziphumo zovavanyo lwe-NT-proBNP.Kuhlalutyo lwethu lovakalelo, xa singabandakanyi izifundo ezimbini ezinenkcazo engabonakaliyo, akukho tshintsho ekusebenzeni kokuxilonga.Okwesihlanu, ukuxilongwa okusekiweyo kokungaphumeleli kwentliziyo akuzange kuvumele ukwahlula phakathi kokungaphumeleli kwentliziyo kunye nokunciphisa iqhekeza le-ejection kunye nokungaphumeleli kwentliziyo kunye neqhekeza eligciniweyo le-ejection.I-48 Ukuxhaphaka okunyukayo kwe-HF kunye neqhezu le-ejection eligciniweyo kwizigulane ezisebekhulile zingachaza ezinye ze-heterogeneity ezibonwa ngokuguga, kodwa izikhokelo zangoku zincoma i-HF kunye ne-ejection fraction kunye ne-EF egciniweyo.Ukungaphumeleli kwentliziyo kusebenzisa umda we-NT-ProBNP efanayo.58 Okwesithandathu, nangona uphando oluninzi luhlala lubhalisa izigulane ezine-dyspnoea enzima, ukuxhaphaka kokungaphumeleli kwentliziyo kwakuphezulu kwaye ukhetho olukhethiweyo lunokuba lukhona.Nangona kunjalo, ukusebenza kwezikhokelo-ezicetyiswayo zokunqunyulwa kwe-NT-proBNP kunye nemida yobudala ayizange itshintshe kuhlalutyo lobuntu, ngaphandle kwezifundo ezinomngcipheko ophezulu wokungakhethi.Okokugqibela, ukungaphumeleli kwentliziyo ebukhali yi-syndrome yeklinikhi, kwaye ukuxilongwa ngokwako kunokungaqiniseki okungokwemvelo kunye nokwahluka kophando.Oku kungaqiniseki kunokuba kukhulu kubantu abadala, okunokuthi ngokuyinxenye kuchaze ukungafani okubonwayo kwiziphumo zokuxilonga.
Sibonise ukuba ukusebenza koxilongo lwe-NT-proBNP yokunqanyulwa kwamaxabiso acetyiswayo kwizikhokelo zokungaphumeleli kwentliziyo ebukhali kuyahluka kwiqela elibalulekileyo lezigulane.Siye saphuhlisa kwaye saqinisekisa inqaku le-CoDE-HF, elidibanisa i-NT-pro-BNP njengomlinganiselo oqhubekayo kunye neenguqu zeklinikhi ukucacisa ukuba kunokwenzeka ukuhluleka kwentliziyo kwizigulane ngamnye usebenzisa imodeli yamanani.Esi sixhobo sokuxhasa isigqibo sichaneke ngokuchanekileyo kwaye sikhuphe ukungaphumeleli kwentliziyo ebuhlungu kwaye senziwa ngokuqhubekayo kuwo onke ama-subgroups.Izifundo ezilindelekileyo okwangoku zifunekayo ukuvavanya impembelelo yokuphumeza esi sixhobo sokuxhasa isigqibo malunga nokusetyenziswa kwezibonelelo zempilo kunye neziphumo zesigulane.
Ukuxilongwa kwentliziyo ebuhlungu kunokuba nzima kuba izigulana zihlala zibonakalisa iimpawu ezingezizo ezodwa.
Uninzi lwezikhokelo zelizwe kunye namazwe ngamazwe zincoma ukuvavanya i-N-terminal B-type natriuretic peptide precursor (NT-proBNP) yokuxilongwa kwentliziyo ebuhlungu.
Uvavanyo lwe-NT-proBNP alukhange lusetyenziswe jikelele ngenxa yeengxaki zokuxilonga kumacandelo abalulekileyo ekliniki yezigulane.
Imigangatho ecetyiswayo ye-NT-proBNP yokusilela kwentliziyo ebukhali kwizikhokelo zinentsebenzo ephantsi yoxilongo kumacandelo abalulekileyo ezigulane.
Isixhobo sokuxhasa isigqibo esiqinisekisiweyo siphuhlisiwe esidibanisa i-NT-pro-BNP njengomlinganiselo oqhubekayo kunye neenguqu zeklinikhi usebenzisa imodeli yamanani.
Esi sixhobo sichaneke ngokuchanekileyo kwaye sikhuphe ukungaphumeleli kwentliziyo ebuhlungu kunayo nayiphi na indlela yokusebenzisa i-NT-proBNP umda wedwa kwaye wenziwa ngokuqhubekayo kuwo onke ama-subgroups.
Zonke izifundo zenziwa ngokuhambelana neSibhengezo saseHelsinki kwaye zavunywa ngokusesikweni ukuvumela ukwabelana ngedatha yenqanaba lesigulane kolu hlalutyo.
Ikhowudi ye-R kunye nedatha engaziwa esetyenziselwa ukuphuhlisa nokuqinisekisa inqaku le-CoDE-HF iyafumaneka kubaphandi ngesicelo sombhali ochaphazelekayo.