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Injongo Ukuhlola ukusebenza kokuxilonga kwe-N-terminal B-type natriuretic peptide precursor (NT-proBNP) ekuhlulekeni kwenhliziyo okukhulu, kanye nokuthuthukisa nokuqinisekisa ithuluzi lokusekela izinqumo elihlanganisa ukugxila kwe-NT-proBNP nezimpawu zomtholampilo.
Senze izifundo eziyi-14 ezivela emazweni ayi-13, okubandakanya izivivinyo ezilawulwa ngokungahleliwe kanye nezifundo zokubheka ezilindelekile.
Idatha ngayinye yezinga lombambi qhaza kusukela ku-10 kuya ku-369 ezigulini ezinezinsolo zokuhluleka kwenhliziyo ebuhlungu yahlanganiswa ukuze kuhlaziywe imeta ukuze kulinganiswe ukunqanyulwa kwe-NT-proBNP.Ithuluzi lokusekela isinqumo (I-Heart Failure Diagnosis and Evaluation Collaboration (CoDE-HF)), elihlanganisa i-NT-proBNP neziguquguqukayo zomtholampilo ukuze kubikwe amathuba okuhluleka kwenhliziyo okunamandla esigulini ngasinye, selithuthukisiwe futhi laqinisekiswa.
Imiphumela.Sekukonke, i-43.9% (4549/10 ~ 369) yeziguli kwatholakala ukuthi inokwehluleka kwenhliziyo okunamandla (73.3% (2286/3119) kanye nama-29.0% (1802/6208) eziguli ezinenhliziyo ehlulekayo nangaphandle kwayo).i-threshold enconyiwe yabaphathi yokunqanyulwa engu-300 pg/mL inevelu yokubikezela engeyinhle engu-94.6% (95% isikhawu sokuzithemba, 91.9% kuya ku-96.4%); naphezu kokusetshenziswa kwemithetho ethile yobudala, inani elihle lokubikezela liye lahluka ku-61.0% (55.3% kuya ku-66.4%), 73.5% (62.3% kuya ku-82.3%), kanye no-80.2% (70.9% kuya ku-87.1%), ezigulini ezineminyaka yobudala <iminyaka engama-50, iminyaka engama-50-75, kanye> neminyaka engama-75, ngokulandelana. naphezu kokusetshenziswa kwemithetho ethile yobudala, inani elihle lokubikezela lihluka ku-61.0% (55.3% kuya ku-66.4%), 73.5% (62.3% kuya ku-82.3%), kanye no-80.2% (70.9% kuya ku-87.1%), ezigulini abaneminyaka engu-<50, iminyaka engu-50-75, futhi> iminyaka engu-75, ngokulandelana. Несмотря на использование возрастных порогов правил, положительная прогностическая ценность варьировала ku-61,0% (kusukela ku-55,3% 4до, 6, 8, 8%, 6%, 6% (kusukela ku-70,9% kuya ku-87,1%) у пациентов в возрасте <50 лет, 50-75 лет и >75 лет соответственно. Naphezu kokusetshenziswa kwemingcele yobudala emithethweni, inani elihle lokubikezela lihluka ku-61.0% (kusuka ku-55.3% kuya ku-66.4%), 73.5% (kusuka ku-62.3% kuya ku-82.3%) kanye no-80.2% (kusuka ku-70.9% kuya ku-87.1%) ezigulini abaneminyaka engu-<50 iminyaka, 50-75 iminyaka kanye> 75 iminyaka, ngokulandelana.Ngaphandle kokusetshenziswa komkhawulo wobudala kulo mthetho, phakathi kweziguli ezindala, amanani okubikezela okuhle ayengama-61.0% (ububanzi obusuka ku-55.3% kuye ku-66.4%), 73.5% (ububanzi obungama-62.3% kuye ku-82.3%) no-80.2% (kusuka ku-70.9) % kuya ku-87.1%).) ukushintsha 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. <iminyaka engama-50, iminyaka engama-50-75 kanye> neminyaka engama-75.Ukubonakaliswa komtholampilo kwahlukahluka emaqenjini amaningi amancane, ikakhulukazi emaqenjini anokukhuluphala ngokweqile, ukwehluleka kwezinso, noma umlando wokuhluleka kwenhliziyo.I-CoDE-HF yayilinganiswe kahle futhi inobandlululo oluhle kakhulu phakathi kweziguli ezinomlando wokuhluleka kwenhliziyo kanye nezingenawo (indawo engaphansi kwe-receiver curve yokusebenza 0.846 (0.830 kuya ku-0.862) kanye ne-0.925 (0.919 kuya ku-0.932), ngokulandelana, kanye ne-Brier score ye-0.130 kanye ne-Brier 0.099, ngokulandelana).).Ezigulini ezingenakho ukwehluleka kwenhliziyo kwangaphambili, ukuxilongwa kwakungaguquki kuwo wonke ama-subgroups namathuba aphansi angu-40.3% (2502/6208) (inani lokubikezela elibi 98.6%, 97.8% kuya ku-99.1%) kanye no-28.0% (1737/6208) amathuba okuba ukuhluleka kwenhliziyo okubuhlungu bekuphezulu (inani elibikezelayo elihle lama-75.0%, 65.7% kuya ku-82.5%).
Iziphetho Ekuhloleni okuhlanganyelwe kwamazwe ngamazwe kokusebenza kokuxilonga kwe-NT-proBNP, imingcele enconyiwe emiqondisweni yokuhlonza ukwehluleka kwenhliziyo ebuhlungu yahlukahluka kakhulu phakathi kwamaqembu amancane esiguli.Ithuluzi Lokusekela Izinqumo le-CoDE-HF lihlanganisa i-NT-proBNP esilinganisweni esiqhubekayo kanye nokunye okuguquguqukayo komtholampilo, okuhlinzeka ngendlela engaguquguquki, enembayo futhi eqondene nawe.
Cishe abantu abayizigidi ezingu-1 e-UK bahlushwa ukuhluleka kwenhliziyo futhi ukwanda kulindeleke ukuthi kukhuphuke cishe ngama-50% kule minyaka engu-25 ezayo ngenxa yokuguga kwabantu.1 Ukuhluleka kwenhliziyo okuncishisiwe kubalelwa ku-5% wakho konke ukulaliswa okungahleliwe.2 Ukuxilongwa okunembile nangesikhathi esifanele kokwehluleka kwenhliziyo okunamandla kungase kube inselele, futhi kokubili imihlahlandlela kazwelonke neyamazwe ngamazwe incoma ukuhlolwa kwe-natriuretic peptides ukusiza ekuxilongweni.345678 Naphezu kwalezi zincomo, ukuhlolwa kwe-N-terminal B-type natriuretic peptide precursor (NT-proBNP) akuzange kwenziwe ngokujwayelekile, ngokwengxenye ngenxa yokukhathazeka mayelana nokusebenziseka kwayo emtholampilo emhlabeni wangempela.Ucwaningo oluphenya ngokusebenza kokuxilonga kwe-NT-proBNP lwenziwe ikakhulukazi emaqenjini amancane akhethiwe eziguli, okunciphisa amandla okwenza imiphumela ibe ngamaqembu amancane abalulekile emtholampilo, njengeziguli esezikhulile neziguli ezinokwehluleka kwezinso noma ukukhuluphala, lapho lezi zici zihluka khona. kahle.ngokuvamile kuvame ezigulini ezinesifo senhliziyo.91011 Izindlela zokumodela zezibalo ezicabangela izici zesiguli ukuze zinikeze izilinganiso eziqondene nomuntu zingase zibe nokusebenza okungaguquki kokuxilonga kuwo wonke amasethi eziguli.12
Nakuba amamodeli amaningi athuthukisiwe ukuze abikezele i-prognosis ezigulini ezinokuhluleka kwenhliziyo, amamodeli ambalwa angasiza ekuhloleni ukuhluleka kwenhliziyo okunamandla.13141516171819 Imizamo yangaphambilini ibe nezinzuzo eziningi kodwa ifake izinto eziguquguqukayo ezizimele njengamathuba okuhlolwa odokotela ngaphambi kokuhlolwa noma izincazelo zesiguli zezimpawu.Ngaphezu kwalokho, bafake i-NT-proBNP njengokuguquguquka kanambambili futhi abazange bacabangele ukusebenzisana okuguquguqukayo nokungaqondile phakathi kwe-NT-proBNP nokunye okuguquguqukayo komtholampilo.Imizamo yangaphambili yokuthuthukisa nokuqinisekisa izilinganiso zokuxilonga iphinde ihlanganise inombolo elinganiselwe yeziguli ezivela esikhungweni esisodwa, esivimbela ukuhlolwa kokusebenza kahle ngaphakathi kwamaqembu amancane futhi sinciphise amathuba okwenziwa kwangaphandle.
Kulokhu kuhlaziya okuhlanganyelwe kwamazwe ngamazwe, sihlole ukusebenza kokuxilonga kwemikhombandlela 'enconyiwe ye-NT-proBNP yokwehluleka kwenhliziyo kusethi yeziguli.Kamuva, sakha futhi saqinisekisa ithuluzi lokusekela izinqumo leziguli ezisolwa ngokuhluleka kwenhliziyo ebukhali esebenzisa imodeli yezibalo ukuhlanganisa ukugxila kwe-NT-proBNP nezici zomtholampilo.
Senze ukubuyekezwa okuhlelekile ukuze sihlonze izifundo ezihlola ukusebenza kokuxilonga kwe-NT-proBNP ezigulini ezisolwa ngokuhluleka kwenhliziyo okubuhlungu.Sibuyekeze isibuyekezo sangaphambilini sika-Roberts et al1 ukuze sifake amagama angukhiye “ukwehluleka kwenhliziyo” kanye “nama-peptide emvelo” ngokusesha i-Embase, i-Medline, kanye neRejista Emaphakathi ye-Cochrane Yezilingo Ezilawulwayo ukuze uthole izihloko nezifinyezo ezishicilelwe ngomhla ka-18 Agasti 2021 (Umbhalo Owengeziwe 1) .Izifundo zazibhekwa njengezifanelekile uma zihlangabezana nalezi zindlela zokufakwa ezichazwe ngaphambilini: ukubhaliswa kweziguli ezineminyaka engu-≥18 ezinezinsolo zokuhluleka kwenhliziyo okubuhlungu esimweni esiphuthumayo, ukukala kwe-NT-proBNP kumasampula egazi atholwe ngesikhathi sokuhlolwa kokuqala kwesiguli ngosuku lokwamukelwa, futhi Ukuxilongwa kwenhliziyo ebuhlungu kwenziwa kusetshenziswa izindinganiso ezamukelekayo zokubhekisela.Abaphenyi ababili (i-KKL kanye ne-MA) babuyekeze ngokuzimela zonke izifundo ezikhonjwe usesho lwezincwadi oluhlelekile, kanti owesithathu (i-NLM) wenze isinqumo sokungqubuzana usebenzisa iphrothokholi echazwe ngaphambilini (ukubhaliswa kwe-PROSPERO: CRD42019159407).
Sithinte ababhali abafanele bawo wonke amaqoqo afanelekayo ukuze bacele ulwazi ngokugxilisa kwe-NT-proBNP, ukuxilongwa okuqinisekisiwe kokwehluleka kwenhliziyo okunamandla, izibalo zabantu (iminyaka yobudala, ubulili, uhlanga), umlando wangaphambili (ukwehluleka kwenhliziyo, isifo se-coronary artery, izinga lesiguli ngasinye esingaziwa) .idatha yesifo sikashukela), umfutho wegazi ophakeme, i-hyperlipidemia, ukubhema, isifuba somoya, isifo samaphaphu esingamahlalakhona, isifo sezinso esingamahlalakhona), imingcele yokuphila (izinga lenhliziyo nomfutho wegazi) ekuhlolweni kokuqala, izici zomtholampilo ze-hematological kanye ne-biochemical.Sibuze bonke ababhali abafanelekile ukuze bathole ukunemba, izincazelo zezinto eziguquguqukayo, nokuphelela ngaphambi kwesivumelwano.Zonke izifundo zenziwe ngokuhambisana neSimemezelo sase-Helsinki futhi zavunyelwa ngokokuziphatha ukuze kuvunyelwe ukwabelana kwedatha ezingeni lesiguli ngasinye salokhu kuhlaziywa kwemeta.Abaphenyi ababili (i-KKL kanye ne-MA) bahlole ngokuzimela ingozi yokuchema kucwaningo ngalunye besebenzisa Ithuluzi Lokuhlola Ikhwalithi Yocwaningo Ekunembeni Kokuhlola, inguqulo 2 (QUADAS-2), kanye nezingxabano ezingu-20 zaxazululwa inkampani yangaphandle (NLM).
Sithole izilinganiso ze-meta ngezikhawu zokuzethemba ezingu-95% zokuzwela, ukucaciswa, inani elibikezelayo elingalungile, kanye nevelu eqagelayo enhle yomhlahlandlela onconyiwe we-NT-proBNP rule-out threshold (300 pg/mL)58 kanye nemithetho ethile yobudala ( 450, 900, kanye no-1800 pg/mL ezigulini ezineminyaka engu-<50, 50-75, kanye > 75 iminyaka, ngokulandelana)7 ekuhlulekeni kwenhliziyo okukhulu ngokusebenzisa indlela yezigaba ezimbili, okulinganiselwe kubalwa ngokwehlukana phakathi kocwaningo ngalunye bese kuhlanganiswe kuzo zonke izifundo. kumodeli yemiphumela engahleliwe e-binomial-evamile kusetshenziswa indlela ye-DerSimonian kanye ne-Laird.21 Siphinde sahlola ukusebenza kwale mikhawulo emaqenjini ashiwo ngaphambilini ahlukaniswa ngeminyaka, ubulili, ubuhlanga, inkomba yesisindo somzimba, ukusebenza kwezinso, i-anemia, kanye nokuba khona i-comorbidities (ukwehluleka kwenhliziyo kwangaphambilini, umfutho wegazi ophakeme, i-hyperlipidemia, isifo sikashukela, i-fibrillation ye-atrial, isifo esingamahlalakhona se-pulmonary pulmonary). 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, хронибонская, хронибонская, хронибленский песни).我们 对 指南 推荐 推荐/ ml) 7, 采用 两 阶段 方法, 在在 项 研究 中中按 年龄, 性别, 体重 体重 体重, 贫血贫血 存在 存在 存在 (既往 心力 衰竭, 高 血压, 高脂血症, 糖尿病, 阻塞 阻塞 心心我们 对 指南 的 NT-pronpnp 排除 阈值 (300 П Ap / мл) 58 和和 的特定的 排除排除 阈值 (对于对于对于 <50,900 分别, 急性急性 分别 1800,900 和 1800 ) 7,评估 按 年龄 性别, 种族, 体重 指数, 肾肾, 和和 合并症 (既往既往 衰竭, 高高 房 高脂血症, 高糖尿病 房房 颤动使用 相同 方法, 我们我们 评估 了 了 NT
Sibale inani (0-100) elihambisana namathuba okuba nokwehluleka kwenhliziyo okunamandla esigulini ngasinye sisebenzisa imodeli yezibalo.Ngenxa yomehluko omkhulu ekwandeni kwe-comorbidities kanye nokwehluleka kwenhliziyo okunamandla, sakha futhi saqinisekisa amamodeli eziguli ezinenhliziyo ehlulekayo nangenayo, ngokulandelana.Sisebenzise ukugxila kwe-NT-proBNP njengesilinganiso esiqhubekayo futhi sakhetha izinjongo eziguquguqukayo ezilula zomtholampilo ezaziwa ukuthi zihlotshaniswa nokwehluleka kwenhliziyo okunamandla okwakunokubaluleka okuphezulu kakhulu okulinganiselwe phakathi nesigaba sokuqeqeshwa semodeli yethu (iminyaka yobudala, izinga lokuhlunga kwe-glomerular elilinganiselwe, i-hemoglobin, imizimba yenkomba enkulu )., ukushaya kwenhliziyo, umfutho wegazi, i-peripheral edema, isifo esingapheli se-pulmonary obstructive nesifo senhliziyo ye-ischemic) (Umbhalo ongeziwe wesi-2).
Ekuthuthukiseni i-Code-HF, sihlole amamodeli ezibalo amane ahlukene: Amamodeli Ahlanganisiwe Emigqa Ejwayelekile, i-Naive Bayes, i-Random Forest, ne-Extreme Gradient Boost (XGBoost) (Umbhalo Owengeziwe 2).222324 Ukuze siphendule ngedatha elahlekile ocwaningweni (Umfanekiso Owengeziwe A), siphindaphinde amadathasethi ayi-10 okubaliwe sisebenzisa imodeli ehlanganyelwe yokuphindaphinda nge-matrix ye-covariance eqondile yocwaningo ehambisana ne-algorithm ye-Monte Carlo Markov.25 Senze ukuphindaphinda okuningi kukho konke okuguquguqukayo okufakwe kumodeli ngaphandle kwe-NT-proBNP.Senze iziphindaphindo ezingu-10 zokuqinisekisa okuphambanayo okuphindwe izikhathi ezingu-10 kumodeli ngayinye futhi sasebenzisa isilinganiso esimaphakathi sokuphindaphinda kanye namasethi edatha afakiwe njengesilinganiso se-CoDE-HF sesiguli ngasinye.Kamuva, sihlonze amaphuzu ahlukanisa ingxenye enkulu yeziguli ezinamathuba aphezulu noma aphansi okuhluleka kwenhliziyo okubuhlungu, nokusebenza okungcono kakhulu kokungafakwa (75% inani lokubikezela elihle kanye nokucaciswa okungu-90%) kanye nokungafakwa (98% inani lokubikezela elibi kanye ne-90 % ukucaciswa) % ukuzwela) ekuhlulekeni kwenhliziyo okubuhlungu.
Sihlole ukusebenza kwemodeli ngayinye kuhlu lwamamethrikhi okuxilonga (indawo engaphansi kwejika elisebenzayo lomamukeli, isikolo se-Brier, ingxenye yeziguli ezithola indlela yokunquma yamathuba aphezulu naphansi, kanye namanani abikezelayo avumayo noma amabi wamaqenjana eziguli).Isikolo se-Brier isilinganiso sokucwasa nokulinganisa esibalwa ngokuthatha iphutha elijwayelekile phakathi kwamathuba abikezelwe nokubonwayo.26 Sikhethe imodeli esebenza kahle kakhulu yethuluzi lokusekela izinqumo ze-Code-HF.Sihlola ukusebenza kwe-CoDE-HF sisebenzisa ukuhlaziya ijika lesinqumo kanye nokuqinisekisa okuphambene kwangaphakathi nangaphandle.Kafushane, le ndlela iphindaphinda indiva isifundo esisodwa ngesikhathi sokuqinisekiswa kwangaphandle futhi isebenzisa izifundo ezisele ukuthuthukisa imodeli.27 Asizange sifake amanani kumadathasethi aqinisekiswe ngaphandle ngakho-ke asizange siqinisekise ngaphandle ezifundweni eziningi.Okuguquguqukayo bekungekho ngokuphelele (Umfanekiso Owengeziwe A).Sisebenzise inguqulo engu-R 4.1.2 kukho konke ukuhlaziya.
Iziguli namalungu ekhomishana yomphakathi babambe iqhaza ekuhunyushweni kwemiphumela.Kunezinhlelo zokusabalalisa imiphumela emphakathini ofanele weziguli.
Sithinte abaphenyi abavela ezifundweni ezifanelekile ezingu-30, ezingu-19 zazo eziphendulile.Izifundo eziyishumi nane (izifundo ze-12 ezizoba yiqembu kanye nezilingo ezimbili ezilawulwa ngokungahleliwe) zinikeze idatha yezinga lesiguli ngasinye kusuka ku-10 kuya ku-369 iziguli ezinezinsolo zokuhluleka kwenhliziyo ebuhlungu (iminyaka yobudala engu-69.3; amadoda angu-53.3%) avela emazweni angu-13 (Ithebula 1).Umfanekiso B;Amathebula Engeziwe A no-B) 15282930313233334353637383940 Zonke izifundo zenziwa emnyangweni wezimo eziphuthumayo, ngaphandle kocwaningo olulodwa oluhlanganisa iziguli zenhliziyo nezamaphaphu (kusho iziguli ze-488 ngocwaningo ngalunye (quartile. Isikhala esincane 322-1053) .Sekukonke, i-43.9% (4549 / 10,369) yeziguli yayinokuxilongwa okuqinisekisiwe kokuhluleka kwenhliziyo ebuhlungu (i-median study prevalence 46% (31-54%)).Ezigulini ezinokwehluleka kwenhliziyo kwangaphambili, izehlakalo zokuhluleka kwenhliziyo ebuhlungu zaziphakeme kuneziguli ezingenakho ukuhluleka kwenhliziyo (73.3% (2286/3119) vs. 29.0% (1802/6208)) (Ithebula Elingeziwe C).
Izici eziyisisekelo zeziguli ezihlungwe ngokuxilonga ukuhluleka kwenhliziyo okunamandla.Amanani ayizinombolo (amaphesenti) ngaphandle uma kuphawulwe ngenye indlela
Ku-threshold yokukhishwa enconyiwe yomhlahlandlela engu-300 pg/mL, ukulinganisa kwe-meta okuhlanganisiwe kwevelu ebikezelayo engalungile, ukuzwela, inani lokubikezela elihle, nokucaciswa kwe-NT-proBNP kumphakathi jikelele kube ngu-94.6% (95% isikhawu sokuzithemba, 91.9%) .kuya ku-96.4%), 96.8% (kusuka ku-94.6% kuya ku-98.1%), 62.9% (kusuka ku-51.3% kuya ku-73.3%) kanye no-49.3% (kusuka ku-35.4 % kuya ku-63.4%) (Umfanekiso 1; Ithebula D Elingeziwe).Sekukonke, i-30.4% (3148/10,369) yeziguli inamazinga e-NT-proBNP angaphansi kuka-300 pg/mL.Kodwa-ke, kwakukhona i-heterogeneity ephawulekayo phakathi kwamaqembu angaphansi kwesiguli kanye nezifundo (Umfanekiso 2; Umfanekiso 3; Amanani Engeziwe C no-D).Amanani okubikezela amabi ayephansi ezigulini ezineminyaka engu-≥75 ubudala (88.2%, kusukela ku-83.5% kuya ku-91.8%), kanye nasezigulini ezinomlando wokuhluleka kwenhliziyo (79.4%, kusuka ku-68.4% kuya ku-87.3%) kanye nokukhuluphala. (90.4%, kusukela ku-84.5% kuya ku-87.3%).94.2%.
I-N-terminal threshold ye-pro-B-type natriuretic peptide (NT-proBNP) ekuhlulekeni kwenhliziyo okubuhlungu.Phezulu kwesokunxele: Inani elibikezelayo elibi lokugxila kwe-NT-proBNP ukuze kukhishwe ukuhlonzwa kokwehluleka kwenhliziyo okubuhlungu.Ngezansi kwesokunxele: Ingxenye eqoqiwe yeziguli ezinezinsolo zokwehluleka kwenhliziyo okubuhlungu ngokugxilisa kwe-NT-proBNP ngaphansi komkhawulo ngamunye.Phezulu kwesokudla: Inani elihle lokubikezela lokugxila kwe-NT-proBNP ukuze kuhlonzwe ukuhluleka kwenhliziyo okubuhlungu.Ngezansi kwesokudla: Ingxenye eqoqwayo yeziguli ezinezinsolo zokwehluleka kwenhliziyo okunamandla okugxilile kwe-NT-proBNP ngaphezu komkhawulo ngamunye.
Ukusebenza kokuxilonga kwemihlahlandlela-okunconyiwe kwe-N-terminal thresholds ye-pro-B-type natriuretic peptide kumaqeqebana angaphansi kwesiguli: umkhawulo wevelu ebikezelwayo ongemuhle ongu-300 pg/mL.COPD = isifo samaphaphu esingamahlalakhona;I-eGFR = isilinganiso esilinganiselwe sokuhlunga kwe-glomerular
Ukusebenza kokuxilonga komhlahlandlela okunconyiwe kwemikhawulo ye-NT-proBNP kuwo wonke ama-subgroups esiguli: inani elihle lokubikezela le-threshold ethile yobudala kuwo wonke ama-subgroups esiguli (450, 900, and 1800 pg/mL for <50, 50-75, kanye > 75 iminyaka, ngokulandelana). Ukusebenza kokuxilonga komhlahlandlela okunconyiwe kwemikhawulo ye-NT-proBNP kuwo wonke ama-subgroups esiguli: inani elihle lokubikezela le-threshold ethile yobudala kuwo wonke ama-subgroups esiguli (450, 900, and 1800 pg/mL for <50, 50-75, kanye > 75 iminyaka, ngokulandelana). 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 kokuxilonga kwemikhawulo enconyiwe ye-NT-proBNP ye-NT-proBNP enconyiwe yamaqeqebana angaphansi kwesiguli: inani elihle lokubikezela lemikhawulo ethile yobudala beqembu lesiguli (450, 900, kanye ne-1800 pg/mL ye-<50, 50-75, kanye > neminyaka engu-75, ngokulandelana) .指南 推荐 的 跨患者 亚组 的 NT-probnp 阈值阈值 诊断 诊断岁）.指南 推荐 的 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 kokuxilonga kwemihlahlandlela-enconyiwe ye-NT-proBNP yamaqeqebana esiguli: inani elihle lokubikezela leminyaka ethile yobudala emaqenjini angaphansi kwesiguli (450, 900, kanye no-1800 pg/mL, <50, 50-75, kanye >75, ngokulandelana kweminyaka yobudala ).COPD = isifo samaphaphu esingamahlalakhona;I-eGFR = isilinganiso esilinganiselwe sokuhlunga kwe-glomerular
Izilinganiso ze-meta ezihlanganisiwe zevelu yokubikezela okuhle kokunqanyulwa kweminyaka yobudala be-NT-proBNP 450, 900, kanye no-1800 pg/mL umthetho bekungu-61.0% (55.3% kuya ku-66.4%), 73.5% (62.3% kuya ku-82). 3%) kanye nama-80.2%, ngokulandelana (70.9% kuya ku-87.1%) (Ithebula 2).Ukucaciswa okuhambisanayo kube ngama-87.8% (79.5% kuya ku-93.0%), 81.1% (72.6% kuya ku-87.5%), kanye nama-73.1% (65.2% kuya ku-79.8%).Sekukonke, ama-48.7% (5052/10,369) eziguli ezinezinsolo zokuhluleka kwenhliziyo okubuhlungu zazine-NT-proBNP ngaphezu kwale mikhawulo yobudala.Naphezu kokuhlukahluka phakathi kwamaqembu eminyaka yobudala, ukusebenza kwezinso, kanye nokusabalala kokwehluleka kwenhliziyo okunamandla, ngaphakathi kwamaqembu amancane, ukunqunywa kweminyaka yemithetho kwakunezindinganiso ezinhle zokubikezela ngaphezu kokusikwa okukodwa kwe-300 pg/mL (I-Supplementary Figure EI) .
Ukusebenza kokuxilonga kwe-N-terminal B-type natriuretic peptide precursor (NT-proBNP) umkhawulo weminyaka wokuhluleka kwenhliziyo okubuhlungu
Sekukonke, sihlonze izifundo eziyisikhombisa ezisengozini enkulu yokuchema (Ithebula Elingeziwe A).Ekuhlaziyeni ukuzwela okukhawulelwe ezifundweni eziphuphuthekiswe ukugxila kwe-NT-proBNP ukuze kunqunywe ukwehluleka kwenhliziyo okunamandla kanye nezifundo ezinengcuphe ephansi yokuchema, izici zokuxilonga ezinconyiwe zezinkombandlela kanye nokunqanyulwa kweminyaka kwe-NT-proBNP ahlalanga angashintshiwe (Amathebula Engeziwe E no-F )..
Umkhawulo ongu-100 pg/mL NT-proBNP uhlangabezane nenqubo yethu engcono kakhulu yokukhishwa enevelu ebikezelayo engalungile ehlanganisiwe engu-97.8% (ububanzi obungu-95.8% ukuya ku-98.8%) kanye nokuzwela okungu-99.3% (ububanzi obungu-98.5% kuya ku-99.7 %) (Ithebula Lokwengeza D) .Kodwa-ke, kuphela i-17.9% (1851/10 ~ 369) yeziguli ezine-NT-proBNP zokugxila ngaphansi kwe-100 pg/mL, futhi zazingezinhle ezigulini esezikhulile kanye neziguli ezinokwehluleka kwenhliziyo, isifo se-coronary artery, kanye nomlando wokuphazamiseka Izibikezelo zihlala zimbi. ..Ukusebenza kwezinso (Umfanekiso J).Ngokufanayo, ukunqanyulwa kwe-NT-proBNP okungu-1000 pg/mL kuhlangabezane nenqubo yethu yokuhlola engcono kakhulu enevelu yokubikezela evumayo engu-74.9% (64.4% kuya ku-83.2%) kanye nokucaciswa okungu-76.1% (65.6% kuya ku-84.2%).laliphansi.Umehluko.Iphinde ibe ngaphansi kuma-subgroups esiguli, ikakhulukazi lawo angenawo umlando wangaphambilini wokuhluleka kwenhliziyo (inani elihle lokubikezela i-62%, i-41% kuya ku-79%) (Ithebula Eyengeziwe D; Umfanekiso Owengeziwe K).
Imodeli yokukhulisa i-gradient eyedlulele (XGBoost) kanye nemodeli exubile yomugqa ojwayelekile bekungamamodeli asebenza kahle kakhulu (indawo engaphansi kwejika kuqembu eliphelele lokuqeqeshwa elingu-0.925 (95% CI 0.919 kuya ku-0.932) kanye no-0.931 (0.925 kuya ku-0.937), ngokulandelanayo) Umbhalo 2).Nakuba ukusebenza kwe-XGBoost kufana namamodeli ahlanganisiwe ajwayelekile, inzuzo eyinhloko ye-XGBoost ikhono layo lokubala amaphuzu uma kunamanani angekho.Lesi isici esibalulekile esethemba ukusisebenzisa kuthuluzi lokusekela izinqumo ze-CoDE-HF ukuze siqhubekisele phambili ukuqaliswa kwalo ekusebenzeni komtholampilo, yingakho sikhethe imodeli ye-XGBoost njengemodeli yokugcina ye-CoDE-HF.
I-CoDE-HF ilinganiswe kahle futhi inobandlululo oluhle kakhulu ezigulini ezinokwehluleka kwenhliziyo nezingenayo (indawo engaphansi kwejika elisebenza komamukeli elingu-0.846 (0.830 kuya ku-0.862) no-0.925 (0.919 kuya ku-0.932) kanye nesikolo se-Brier sika-0.130 no-0.130, ngokulandelana).0.099) (Umdwebo 4; I-Fig. L eyengeziwe).Isikolo se-CoDE-HF sika-4.7 sinikeza inani elibikezelwayo elibi lika-98.6% (97.8% kuya ku-99.1%) kanye nokuzwela okungu-98.1% (96.9% kuya ku-98.9%) (Ithebula Elingeziwe G) , futhi amaphuzu angu-51.2 ahlinzeka ngokubikezela okuhle inani.inani 75.0% (65.7%) 82.5%), ukucaciswa kwakungu-92.2% (87.5% kuya ku-95.2%) weziguli ezingenawo umlando wokuhluleka kwenhliziyo.Lezi zilinganiso zokufakwa kanye nokukhishwa kwakunokusebenza okufanayo kokuxilonga kuwo wonke ama-subgroups (Umfanekiso 5, Umfanekiso 6, Umfanekiso 7). Uma lezi zibalo bezisetshenziswa ezigulini ezisolwa ngokuhluleka kwenhliziyo okubuhlungu, i-CoDE-HF ibiyohlonza u-40.3% (2502/6208) emathubeni aphansi (<4.7) kanye no-28.0% (1737/6208) emathubeni aphezulu (≥51.2) ukuhluleka kwenhliziyo okukhulu. Uma lezi zibalo bezisetshenziswa ezigulini ezisolwa ngokuhluleka kwenhliziyo okubuhlungu, i-CoDE-HF ibiyohlonza u-40.3% (2502/6208) emathubeni aphansi (<4.7) kanye no-28.0% (1737/6208) emathubeni aphezulu (≥51.2) ukuhluleka kwenhliziyo okukhulu. 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. Uma lezi zilinganiso bezisetshenziswa ezigulini ezisolwa ngokuhluleka kwenhliziyo okubuhlungu, i-CoDE-HF ingathola u-40.3% (2502/6208) okungenzeka ukuthi uphansi (<4.7) kanye no-28.0% (1737/6208) okungenzeka kakhulu (≥51.2) inhliziyo. ukwehluleka.ukuhluleka kwenhliziyo okukhulu.如果 将 这些 评分 应用 于 疑似 急性 心力 的衰竭 的衰竭衰竭.如果 将 这些 评分 应用 于 急性 心力 衰竭衰竭,, ikhodi-hf 识别 出 出 40 40% (2502/620 ) 急性 心力 心力 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急 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. Uma lezi zibalo zisetshenziswe ezigulini ezisolwa ngokuhluleka kwenhliziyo ebuhlungu, i-CoDE-HF izodalula u-40.3% (2502/6208) amathuba aphansi (<4.7) kanye nama-28.0% (1737/6208) amathuba aphezulu (≥ 51.2) ukwehluleka kwenhliziyo okukhulu.ukukhathala.Phakathi kweziguli ezinokuhluleka kwenhliziyo okwakukhona ngaphambili, awekho amaphuzu eqenjini lokuqeqesha afinyelele imibandela yethu yokukhishwa okuhlosiwe.Isikolo se-CoDE-HF sasingu-84.5, inani elihle lokubikezela lalingu-92.7% (89.1% kuya ku-95.2%), futhi ukucaciswa kwaba ngu-90.2% (84.0% kuya ku-94.1%).Lokhu kuhlola kuzokhomba i-45.5% (1420 / 3119) yeziguli ezinethuba eliphezulu lokuthuthukisa ukuhluleka kwenhliziyo okunamandla (Fig. 8).Ekuhlaziyeni ijika lesinqumo kuwo wonke amathuba omkhawulo, i-CoDE-HF ibe nenzuzo ephezulu kune-NT-proBNP iyodwa (Umfanekiso Owengeziwe M).Izikolo ze-CoDE-HF zancishiswa kancane ngaphandle komlando wokuqeqeshwa (indawo engaphansi kwejika elisebenzayo le-receiver yayingu-0.922 (0.916 kuya ku-0.929) kanye ne-0.841 (0.825 kuya ku-0.825 ezigulini ezingenakho ukuhluleka kwenhliziyo nokuhluleka kwenhliziyo yangaphambi kwenhliziyo) 0.857).Ukuqinisekisa okuphambanayo kwangaphakathi nangaphandle kusebenze kahle kuqoqo lawo womabili amamodeli (Umfanekiso Owengeziwe N).
I-Heart Failure Joint Diagnosis and Evaluation Scale (CoDE-HF) yalinganiswa engxenyeni ebonwayo yeziguli ezinokwehluleka kwenhliziyo okubuhlungu.Umugqa wamachashazi ubonisa ukulinganiswa okufanele.Iphuzu ngalinye lihambisana neziguli eziyi-100.Phezulu: Ukulinganisa kwe-CoDE-HF esigulini ngaphandle kokuhluleka kwenhliziyo kwangaphambili.Ngezansi: Ukulinganisa kwe-CoDE-HF esigulini esinomlando wokuhluleka kwenhliziyo.
Ukusebenza kokuxilonga kwe-Heart Failure Collaborative Diagnosis and Evaluation Scale (CoDE-HF) emaqenjini angaphansi esiguli.Isilinganiso sokukhishwa kwe-CoDE-HF sibe nenani elibi lokubikezela le-4.7 eqenjini elincane leziguli ezingenawo umlando wokuhluleka kwenhliziyo.I-CoDE-HF isebenzisa i-N-terminal natriuretic peptide type B precursor concentrations njengezilinganiso eziqhubekayo kanye nezinjongo eziguquguqukayo ezilula ezichazwe kusengaphambili (iminyaka, isilinganiso se-glomerular filtration rate (eGFR), i-hemoglobin, inkomba yesisindo somzimba, izinga lokushaya kwenhliziyo, umfutho wegazi, i-peripheral edema, ukuvimbela okungamahlalakhona. Isifo se-pulmonary (COPD) kanye nesifo senhliziyo) sinikeza ukuhlolwa komuntu ngamunye kwamathuba okuxilongwa kokuhluleka kwenhliziyo okunamandla.
Ukusebenza kokuxilonga kwesikali se-CoDE-HF Ekuhlanganyeleni Kokuxilonga Nokuhlola Isikali Sokuhluleka Kwenhliziyo emaqenjini amancane eziguli.I-CoDE-HF rule score yayinenani elihle lokubikezela le-51.2 eqenjini elincane leziguli ezingenawo umlando wokuhluleka kwenhliziyo.I-CoDE-HF ihlanganise ukugxila kwe-NT-proBNP njengezilinganiso eziqhubekayo kanye nezinjongo eziguquguqukayo ezilula ezichazwe kusengaphambili (iminyaka yobudala, isilinganiso esilinganiselwe sokuhlunga kwe-glomerular (eGFR), i-hemoglobin, inkomba yesisindo somzimba, izinga lokushaya kwenhliziyo, umfutho wegazi, i-peripheral edema, isifo esingamahlalakhona sokuvimbela amaphaphu (COPD) ).I-coronary artery disease) ihlinzeka ngokuhlolwa komuntu ngamunye kwamathuba okuxilongwa kwesifo senhliziyo esibuhlungu
Ukusebenza kokuxilonga Kokubambisana Kokuxilongwa Nokuhlola Isikali Sokuhluleka Kwenhliziyo (CoDE-HF) emaqenjini angaphansi esiguli.I-CoDE-HF rule score yayinenani elihle lokubikezela lama-84.5 ezigulini ezinomlando wokuhluleka kwenhliziyo eqenjini elincane leziguli.I-CoDE-HF ihlanganise ukugxila kwe-NT-proBNP njengezilinganiso eziqhubekayo kanye nezinjongo eziguquguqukayo ezilula ezichazwe kusengaphambili (iminyaka yobudala, isilinganiso esilinganiselwe sokuhlunga kwe-glomerular (eGFR), i-hemoglobin, inkomba yesisindo somzimba, izinga lokushaya kwenhliziyo, umfutho wegazi, i-peripheral edema, isifo esingamahlalakhona sokuvimbela amaphaphu (COPD) ).I-coronary artery disease) ihlinzeka ngokuhlolwa komuntu ngamunye kwamathuba okuxilongwa kwesifo senhliziyo esibuhlungu
I-Heart Failure Joint Diagnosis and Assessment Scale (CoDE-HF) ayisebenzi ekuxilongeni ezigulini ezinomlando wokuhluleka kwenhliziyo.Phezulu: Amanani abikezelayo angemuhle futhi avumayo wezikolo ze-CoDE-HF.Ulayini onamachashazi ohlaza okwesibhakabhaka oqondile ukhombisa amaphuzu okuqeda okuhlosiwe angu-4.7.Ulayini onamachashazi aqondile obomvu ubonisa isikolo esiqondiwe somthetho ongu-51.2.Ngezansi: imephu yokuminyana yezikolo ze-CoDE-HF ezigulini ezingenawo umlando wokuhluleka kwenhliziyo.Izinhloso zokukhishwa kanye nokubusa zihlonze i-40.3% yeziguli ezinamathuba aphansi kanye nama-28.0% anamathuba aphezulu, ngokulandelanayo.
Iziguli ezihlonzwe njengamathuba aphansi yi-CoDE-HF zibe nezimbangela eziphansi kakhulu zokufa kanye nokufa kwe-CV ezinsukwini ezingama-30 nonyaka ongu-1 kuneziguli ezihlonzwe njengamathuba aphakathi nendawo naphezulu (izinsuku ezingama-30 zokufa yimbangela: 1. 0% uma kuqhathaniswa no-4.0 % kanye no-10.4%).ukufa kwazo zonke izimbangela phakathi nonyaka owodwa: 5.9% uma kuqhathaniswa no-17.8% no-33.4%, ngokulandelana;Ukufa kwezinsuku ezingu-30 ngenxa yezifo zenhliziyo: 0.2% vs. 0.8% no-4.1%;ukufa kwaminyaka yonke okuvela ezifweni zenhliziyo: 1.4% ngokumelene ne-3.4% ne-16.3%, ngokulandelana) (Fig. 9). Ezigulini ezine-NT-proBNP yokugxila engu-<300 pg/mL uma kuqhathaniswa nalezo ≥300 pg/mL, zonke izimbangela zokufa zazingu-0.8% uma ziqhathaniswa no-7.6% ezinsukwini ezingu-30 kanye no-5.9% ngokuqhathaniswa no-26.6% ngonyaka owodwa, ngokulandelana, futhi amazinga okufa kwenhliziyo nemithambo yegazi ayengu-0.1% uma kuqhathaniswa no-2.6% ezinsukwini ezingu-30 kanye no-1.3% uma kuqhathaniswa no-10.2% onyakeni owodwa, ngokulandelana (ithebula elingeziwe H; isibalo O). Ezigulini ezine-NT-proBNP yokugxila engu-<300 pg/mL uma kuqhathaniswa nalezo ≥300 pg/mL, zonke izimbangela zokufa zazingu-0.8% uma ziqhathaniswa no-7.6% ezinsukwini ezingu-30 kanye no-5.9% ngokuqhathaniswa no-26.6% ngonyaka owodwa, ngokulandelana, futhi amazinga okufa kwenhliziyo nemithambo yegazi ayengu-0.1% uma kuqhathaniswa no-2.6% ezinsukwini ezingu-30 kanye no-1.3% uma kuqhathaniswa no-10.2% onyakeni owodwa, ngokulandelana (ithebula elingeziwe H; isibalo 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, 6,8 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). Ezigulini ezinokuhlushwa kwe-NT-proBNP ngaphansi kwama-300 pg/ml uma kuqhathaniswa nalokho okungaphansi kuka-300 pg/ml, ukufa okuyimbangela kwakungu-0.8% uma kuqhathaniswa no-7.6% ezinsukwini ezingu-30 kanye no-5.9% uma kuqhathaniswa nama-26, 6% ngonyaka owodwa, ngokulandelana. , kanye namazinga okufa kwe-CV abengu-0.1% uma kuqhathaniswa no-2.6% ezinsukwini ezingu-30 kanye no-1.3% uma kuqhathaniswa no-10.2% ngonyaka owodwa, ngokulandelana (Ithebula Elingezelelwe H; Umfanekiso Owengeziwe). NT-proBNP 浓度<300 pg/mL 的患者与≥300 pg/mL 的患者相比，30 天全因死亡率分别為0.8% 和約无 0.8% 和約无6%, 30 天全因死亡率分别為0.8% 和約无 6% 和紵无6%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 為心为 為 0.8% ne 7.6% , 9 .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）. Пациенты с концентрацией NT-proBNP <300 пг/мл по сравнению с ≥300 пг/мл имели 30-дневную смертность от всех причин 0,8% 0,6%, 6%, 6%, 6% года, а также сердечно-сосудистую смертность. Iziguli ezinokugxilisa kwe-NT-proBNP <300 pg/mL uma kuqhathaniswa no-≥300 pg/mL zibe nokufa kwesizathu sezinsuku ezingu-30 okungu-0.8% no-7.6%, ngokulandelana, 5.9% no-26.6% phakathi nonyaka owodwa, nokufa kwenhliziyo nemithambo yegazi.bekungu-0.1% no-2.6% ezinsukwini ezingama-30 kanye no-1.3% no-10.2% ngonyaka ongu-1 (Ithebula Elingeziwe H; Umfanekiso Owengeziwe).
Izinga lokufa elikhulayo lembangela yonke lihlelwe Ngokuhlanganyela Kokuhlonza Nokuhlola Ukwehluleka Kwenhliziyo (CoDE-HF) iqembu lamathuba
Senze ukuhlaziywa kwemeta kwedatha yezinga lesiguli ngasinye ukuze sihlole ukusebenza kokuxilonga kwe-NT-proBNP ezigulini ezingaphezu kweziyi-10 ezinezinsolo zokwehluleka kwenhliziyo okunamandla okufakwe ezifundweni ezilindelwe eziyi-14 ezivela emazweni ayi-13 esiziklame saphinde sazisebenzisa sisebenzisa i-NT-proBNP.I-proBNP njengethuluzi lokusekela izinqumo lokulinganisa okuqhubekayo.Sibika okutholakele okumbalwa okubalulekile.Okokuqala, imikhawulo enconyiwe yomhlahlandlela yokungabandakanyi ukwehluleka kwenhliziyo okunamandla ayifani kuwo wonke amaqeqebana abalulekile esiguli.3 Nakuba inani labantu elivamile namaqeqebana ambalwa, okuhlanganisa iziguli ezisencane nabesifazane, asebenze kahle, iziguli ezindala kanye nabesifazane babenezindinganiso eziphansi zokubikezela ezimbi kakhulu.Ezigulini ezinokukhuluphala ngokweqile noma ukwehluleka kwenhliziyo kwangaphambili, izinga elingelona iqiniso elibi lalisuka kokukodwa kokuyishumi kuya kokukodwa kwabahlanu.Okwesibili, imingcele yobudala ibonise kahle ekuxilongweni kokuhluleka kwenhliziyo okunamandla.Kodwa-ke, inani elihle lokubikezela laliphansi ezigulini ezincane.Okwesithathu, nakuba ukuncishiswa kwethu kwe-NT-proBNP okuthuthukisiwe kwe-100 pg/mL ukuze kukhishwe ukwehluleka kwenhliziyo okunamandla kanye no-1000 pg/mL ukuze kulawule ukwehluleka kwenhliziyo okubuhlungu kunenani elihle kakhulu lokubikezela elibi futhi elihle kubantu abaningi, iziguli ezindala zisesimweni esibi kakhulu. .ezigulini ezinokuhluleka kwenhliziyo okubuhlungu.Ukuhluleka kwenhliziyo kwangaphambilini nokukhuluphala.Okokugcina, sithuthukise futhi saqinisekisa ithuluzi lokusekela izinqumo, isikolo se-CoDE-HF, ngokusebenza okuhle kakhulu kokuxilonga kuwo wonke ama-subgroups esiguli.Leli thuluzi lokusekela isinqumo alibandakanyi futhi lakhipha ukuhluleka kwenhliziyo okubuhlungu ngokunembe kakhulu kunanoma iyiphi indlela kusetshenziswa kuphela umkhawulo we-NT-proBNP.
Ngokwazi kwethu, lolu ucwaningo olukhulu kunazo zonke kuze kube manje oluhlola ukusebenza kokuxilonga kwe-NT-proBNP ekuhlulekeni kwenhliziyo okubuhlungu.Zonke izifundo ezifakiwe zazilindelekile futhi ukuxilonga kokugcina kwenziwa yiphaneli yodokotela besebenzisa lonke ulwazi olutholakalayo.Kubalulekile ukuqaphela ukuthi ukutholakala kwedatha ezingeni lesiguli ngasinye kubantu abaningi bocwaningo kuvumela ukuhlolwa okuthembekile kokusebenza kokuxilonga kwayo yonke imingcele ye-NT-proBNP engenzeka emaqenjini amancane eziguli, kanye nokuthuthukiswa nokuqinisekiswa kwezikali ezintsha zokuxilonga.
Imihlahlandlela eminingi kazwelonke neyamazwe ngamazwe incoma ukusebenzisa inani elinqunyiwe le-NT-proBNP elingu-300 pg/mL ukuze kukhishwe ukwehluleka kwenhliziyo okubuhlungu58 ngokusekelwe ezifundweni eziningi zangaphambilini344142 ezibika inani lokubikezela elibi lama-98% kulokhu kunqanyulwa.ukusebenza kokuxilonga kwamaqeqebana abalulekile eziguli akukwazanga ukuhlolwa.Ucwaningo lwethu lubhalise iziguli eziningi ngokuphindwe kathathu kunokuhlaziywa kwe-meta kwezinga locwaningo lwangaphambilini, i-3 ebonise inani eliphansi lokubikezela elingalungile ekusikeni kwe-300 pg/mL nge-meta-estimation ehlanganisiwe yama-94.6%.Okubaluleke nakakhulu, inani elibi lokubikezela laliphansi kakhulu kuma-subgroups abalulekile njengeziguli esezikhulile kanye neziguli ezinokuhluleka kwenhliziyo okukhona ngaphambili, isifo se-coronary artery, kanye nokukhuluphala.Ukwengeza, cishe i-70% yeziguli zine-NT-proBNP yokugxila ngaphezu kwe-300 pg/ml cut-off point, eqokomisa ukulinganiselwa kokusebenzisa iphuzu elilodwa lokusika ekusebenzeni.Nakuba i-cutoff ephansi ye-100 pg/mL izuze inani elibi lokubikezela elibi lika-98%, lenze kabi eqenjini elincane leziguli.Ukwengeza, iminyaka yobudala kanye nemikhawulo elungiselelwe yokwehluleka kwenhliziyo okukhulu kubonise ukungafani phakathi kwamaqembu amancane esiguli, ikakhulukazi kulabo abangenawo umlando wangaphambili wokuhluleka kwenhliziyo.Lokhu kuhlukahluka ekusebenzeni kokuxilonga kuyakhathaza kakhulu njengoba iminyaka yethu yeziguli futhi kunezinye izifo eziningi.Lokhu kuphakamisa umbuzo wokuthi ngabe imihlahlandlela yomtholampilo kufanele iqhubeke nokutusa ukusetshenziswa kwe-uniform cut-offs lapho i-NT-proBNP ithintwa yizici eziningi zobungozi kanye ne-commorbidities.
Ukuze sithuthukise usizo lomtholampilo lwe-NT-proBNP, sithuthukise futhi saqinisekisa ngaphandle ukuhlolwa kwe-CoDE-HF kwethuluzi lokusekela izinqumo zomtholampilo.Leli phuzu lihlanganisa i-NT-proBNP njengesilinganiso esiqhubekayo esinezinjongo eziguquguqukayo ezilula zomtholampilo ukuze kuhlinzekwe ukuhlolwa komuntu ngamunye kwamathuba okuxilongwa kokwehluleka kwenhliziyo okubuhlungu.Sibonisa ukuthi ukusebenza kokuxilonga kwesikolo se-CoDE-HF kuqinile emaqenjini amancane eziguli.I-CoDE-HF ikwazile ukukhipha futhi yakhipha ukuxilongwa kwesifo senhliziyo esibuhlungu engxenyeni enkulu yeziguli kunomkhawulo we-NT-proBNP olungiselelwe kuphela.Ngaphezu kwalokho, ekuhlaziyeni kwethu ijika lesinqumo, sithole ukuthi i-CoDE-HF inenzuzo enkulu kune-NT-proBNP iyodwa, kulo lonke uhla lwamathuba omkhawulo.Sikholelwa ukuthi lesi siphetho sinengqondo njengoba i-NT-proBNP iwumaka oqhubekayo wengozi futhi ukugxila kwayo kuncike kwezinye izici ezihlobene nesiguli njengenkomba yesisindo somzimba, ubudala, nokusebenza kwezinso.434445 Nakuba lezi zilinganiso zisekelwe kumbandela wokusebenza ochazwe kusengaphambili, siyaqaphela ukuthi le migomo ingase ingasekelwe emhlabeni wonke nokuthi izikhungo zokunakekelwa kwezempilo ezihlukene zingase zibe nokubekezelela ubungozi okuhlukile.Inzuzo yokusebenzisa amathuluzi okusekela izinqumo njenge-CoDE-HF iwukuthi odokotela noma izikhungo zingakhetha indlela yokusebenza yokuxilonga ezosetshenziselwa ukwenza izinqumo zendawo ngokusekelwe ezintweni eziza kuqala kubo kanye nokuba khona kwe-echocardiography noma ochwepheshe bokuhluleka kwenhliziyo..
Silindele ukuthi ithuluzi lethu elisha lokusekela izinqumo, i-Code-HF, lingathuthukisa ukuhlolwa kweziguli ezinezinsolo zokwehluleka kwenhliziyo okunamandla okubonwa emisebenzini ehlukahlukene yezokwelapha futhi liguqule ukunakekelwa kwazo, kube lula ukuxilonga okunembe kakhudlwana.Ucwaningo lwangaphambili lubonise ukuthi ukwelashwa okufika ngesikhathi nokunembile okusekelwe ebufakazini kweziguli ezinenhliziyo ebuhlungu kunganciphisa kakhulu ukufa nobude besibhedlela, futhi ukubambezeleka kuhlotshaniswa nemiphumela emibi kakhulu.46 Ngaphezu kwalokho, i-CoDE-HF eqoqwe njalo isebenzisa okuguquguqukayo ngakho-ke ingafakwa ekugelezeni komsebenzi womtholampilo njengengxenye yendlela yokunquma yomnyango wezimo eziphuthumayo ukuze kunikwe amandla ukuhlola okusebenza kahle kakhudlwana.Njengamanje, iningi leziguli ezinezinsolo zokwehluleka kwenhliziyo okuyingozi kakhulu zine-echocardiography lapho zilaliswa khona ukuze zinqume ukwelashwa kwazo, kodwa yiqembu elincane kuphela leziguli eligcina litholakele.2 I-Echocardiography iwucwaningo lokukhethekile oludla isikhathi nolusebenzisa kakhulu izinsiza Silindele ukuthi ukusetshenziswa kwe-CoDE-HF ukuze kusetshenziswe izinsiza ezikhethekile ezinembile nezinolwazi ezifana ne-echocardiography kungaholela ekongeni kwezindleko nokusebenza kahle kohlelo lokunakekelwa kwezempilo..Ukwengeza, ukonga izindleko kungafinyelelwa ngokwelashwa kweziguli ezingaphandle kweziguli ezisengozini encane.Ucwaningo olulindelekile okwamanje luyadingeka ukuze kuhlolwe ukusebenza ngempumelelo komtholampilo kanye nezindleko zemikhawulo ehlukene yesinqumo se-CoDE-HF ekusebenzeni komtholampilo.
Sivuma ukulinganiselwa okuningana.Okokuqala, sikwazile ukuthola idatha yezinga lesiguli ngasinye yezifundo ezingu-14 kwezingu-30 ezihlangabezana nenqubo yethu yokufaneleka, ngakho-ke ukukhethwa kokukhetha kungase kwethulwe.Kodwa-ke, izifundo ezifanelekile ezazingafakwanga zazinokusabalala okufanayo kokwehluleka kwenhliziyo okunamandla, izinsuku zokushicilelwa, kanye nokutholakala kwendawo, futhi imiphakathi yayinezici ezifanayo zokubala kwabantu nezomtholampilo kubantu abahlanganisiwe.Okwesibili, lapho ulwazi oluvela ezifundweni eziningi luhlanganiswa, ezinye izifundo zazishoda ngedatha kwezinye izinto eziguquguqukayo.Ukuze sandise ukusetshenziswa kolwazi, sisebenzise indlela yokulandelana yokufaka okuningi.Okwesithathu, asizange sirekhode idatha ye-ECG neye-X-ray yesifuba ngokulandelana ukuze siyifake kumodeli yethu.Ukuhunyushwa kwe-NT-proBNP ezigulini ezisolwa ngokuhluleka kwenhliziyo ebuhlungu kufanele kwenziwe ngokuhambisana nalezi zifundo, i-47 kanye nezifundo ezengeziwe ziyadingeka ukuze kutholakale ukuthi izindlela ezihlanganisa lezi zifundo zingathuthukisa yini izikolo ze-CoDE-HF.Okwesine, akuzona zonke izifundo ezenze ukuxilonga ngaphandle kokucabangela imiphumela yokuhlolwa kwe-NT-proBNP.Ekuhlaziyeni kwethu ukuzwela, lapho singabandakanyi izifundo ezimbili ezinencazelo engabonakali, kwakungekho ushintsho ekusebenzeni kokuxilonga.Okwesihlanu, ukuxilongwa okuqinisekisiwe kokuhluleka kwenhliziyo okunamandla akuzange kuvumele ukuhlukanisa phakathi kokuhluleka kwenhliziyo ngokunciphisa ingxenye ye-ejection kanye nokuhluleka kwenhliziyo nge-fraction ejection egciniwe.48 Ukusabalala okwandayo kwe-HF enengxenye yokukhipha elondoloziwe ezigulini esezikhulile kungase kuchaze okunye ukuhlukahluka okubonwa ngokukhula, kodwa imihlahlandlela yamanje incoma i-HF enengxenye encishisiwe yokukhipha kanye ne-EF elondoloziwe.Ukwehluleka kwenhliziyo kusebenzisa umkhawulo ofanayo we-NT-ProBNP.58 Okwesithupha, nakuba ucwaningo oluningi luhlala lubhalisa iziguli ezine-dyspnoea eyingozi, ukusabalala kokuhluleka kwenhliziyo okunamandla kwakuphezulu futhi ukukhethwa kokukhetha kungase kube khona.Kodwa-ke, ukusebenza kahle kwemihlahlandlela-okunconyiwe kwe-NT-proBNP nemikhawulo yobudala akuzange kushintshe ekuhlaziyeni ukuzwela, ngaphandle kwezifundo ezinengcuphe enkulu yokuchema.Okokugcina, ukwehluleka kwenhliziyo okunamandla kuyisifo somtholampilo, futhi ukuxilongwa ngokwako kunokungaqiniseki okungokwemvelo nokuhlukahluka kocwaningo.Lokhu kungaqiniseki kungase kube kukhulu kubantu asebekhulile, okungase kuchaze ngokwengxenye ukuhlukahluka okubonwayo emiphumeleni yokuxilonga.
Sikhombisile ukuthi ukusebenza kokuxilonga kwamanani anqunyiwe we-NT-proBNP anconywe kuzinkombandlela zokwehluleka kwenhliziyo okubuhlungu kuyehluka eqenjini elincane leziguli.Sithuthukise futhi saqinisekisa isikolo se-CoDE-HF, esihlanganisa i-NT-pro-BNP njengesilinganiso esiqhubekayo neziguquguqukayo zomtholampilo ukuze sinqume ukuthi kungenzeka yini ukwehluleka kwenhliziyo okunamandla ezigulini ngazinye zisebenzisa imodeli yezibalo.Leli thuluzi elisekela isinqumo likhishwe ngokunembile futhi lakhipha ukuhluleka kwenhliziyo okukhulu futhi lenziwa ngokungaguquki kuwo wonke ama-subgroups.Izifundo ezisazokwenzeka okwamanje ziyadingeka ukuze kuhlolwe umthelela wokusebenzisa leli thuluzi lokusekela izinqumo ekusetshenzisweni kwezinsiza zokunakekelwa kwezempilo kanye nemiphumela yesiguli.
Ukuxilongwa kwenhliziyo ebuhlungu kungase kube nzima ngoba iziguli zivame ukuba nezimpawu ezingaqondile.
Imihlahlandlela eminingi kazwelonke neyamazwe ngamazwe incoma ukuhlola i-N-terminal B-type natriuretic peptide precursor (NT-proBNP) ukuze kutholwe ukuhluleka kwenhliziyo okubuhlungu.
Ukuhlolwa kwe-NT-proBNP akuzange kusetshenziswe emhlabeni wonke ngenxa yezinkinga zokusebenza kokuxilonga emaqenjini angaphansi abalulekile eziguli.
Imikhawulo enconyiwe ye-NT-proBNP yokuhluleka kwenhliziyo ebuhlungu emiqondisweni inokusebenza okungekuhle uma kuqhathaniswa namaqoqo amancane esiguli.
Ithuluzi eliqinisekisiwe lokusekela izinqumo lakhiwe elihlanganisa i-NT-pro-BNP njengesilinganiso esiqhubekayo neziguquguqukayo zomtholampilo kusetshenziswa ukumodela kwezibalo.
Leli thuluzi likhishwe ngokunembe kakhulu futhi lakhipha ukwehluleka kwenhliziyo okukhulu kunanoma iyiphi indlela esebenzisa umkhawulo we-NT-proBNP iyodwa futhi lenziwa ngokungaguquki kuwo wonke ama-subgroups.
Zonke izifundo zenziwe ngokuhambisana neSimemezelo sase-Helsinki futhi zavunyelwa ngokokuziphatha ukuze kuvunyelwe ukwabelana kwedatha yezinga lesiguli kulokhu kuhlaziywa.
Ikhodi engu-R kanye nedatha engaziwa esetshenziselwa ukuthuthukisa nokuqinisekisa isikolo se-CoDE-HF iyatholakala kubacwaningi ngesicelo sombhali ofanele.