Amakuru

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Intego Gusuzuma imikorere yo gusuzuma ya N-terminal B yo mu bwoko bwa natriuretic peptide precursor (NT-proBNP) imbibi zumutima ukabije, no guteza imbere no kwemeza igikoresho gishyigikira ibyemezo gihuza kwibanda kwa NT-proBNP nibimenyetso byubuvuzi.
Yakoze ubushakashatsi 14 buturutse mu bihugu 13, harimo ibigeragezo byateganijwe hamwe n’ubushakashatsi bwo kureba.
Umuntu ku giti cye yitabiriye amakuru kuva ku barwayi 10 kugeza kuri 369 bafite ikibazo cy’umutima ukabije w’umutima bahurijwe hamwe kugira ngo basuzume meta-igereranya kugereranya NT-proBNP.Igikoresho cyo gufata ibyemezo (Gusuzuma Umutima Kunanirwa no Gusuzuma Ubufatanye (CoDE-HF)), bihuza NT-proBNP hamwe n’imihindagurikire y’amavuriro kugira ngo bigaragaze ko bishoboka ko umutima ukabije w’umutima ku barwayi ku giti cyabo, wateguwe kandi uremezwa.
Ibisubizo.Muri rusange, 43.9% (4549/10 ~ 369) by'abarwayi basuzumwe indwara z'umutima zikabije (73.3% (2286/3119) na 29.0% (1802/6208) z'abarwayi bafite ikibazo cyo kunanirwa k'umutima mbere).ubuyobozi bwasabwe guhagarikwa kurenza 300 pg / mL bifite agaciro keza ko guhanura 94,6% (95% intera y'icyizere, 91.9% kugeza 96.4%); nubwo hakoreshwa imyaka yihariye igenwa, agaciro keza ko guhanura karatandukanye kuri 61.0% (55.3% kugeza 66.4%), 73.5% (62.3% kugeza 82.3%), na 80.2% (70.9% kugeza 87.1%), kubarwayi bafite imyaka <Imyaka 50, 50-75, na> imyaka 75, uko bikurikirana. nubwo hakoreshwa imyaka yihariye igenamigambi, agaciro keza ko guhanura karatandukanye kuri 61.0% (55.3% kugeza 66.4%), 73.5% (62.3% kugeza 82.3%), na 80.2% (70.9% kugeza 87.1%), mubarwayi imyaka <imyaka 50, 50-75, na> imyaka 75, uko bikurikirana. Несмотря на использование возрастных порогов правил, положительная прогностическая ценность варьировала в 61,0% (от 55,3% до 66,4%), 73,5% (от 62,3% до 82,3%) na 80,2% . Nubwo hakoreshwa imyaka ntarengwa mu mategeko, agaciro keza ko guhanura karatandukanye muri 61.0% (kuva 55.3% kugeza kuri 66.4%), 73.5% (kuva 62.3% kugeza 82.3%) na 80.2% (kuva 70.9% kugeza 87.1%) kubarwayi imyaka <50 ans, 50-75 ans na> 75 ans, kimwe.Nubwo hakoreshwa imyaka ntarengwa mu mategeko, mu barwayi bakuze, indangagaciro nziza zo guhanura zari 61.0% (intera 55.3% kugeza 66.4%), 73.5% (intera 62.3% kugeza 82.3%) na 80. 2% (kuva 70.9 % kugeza kuri 87.1%).) guhinduka hagati. <50 岁 、 50-75 岁 和> 75 岁。 <50 岁 、 50-75 岁 和> 75 岁。 <50 лет, 50-75 лет и> 75 лет. <Imyaka 50, imyaka 50-75 na> imyaka 75.Kugaragara kwa Clinical byagaragaye mumatsinda menshi, cyane cyane mumatsinda afite umubyibuho ukabije, kubura impyiko, cyangwa amateka yo kunanirwa k'umutima.CoDE-HF yahinduwe neza kandi ifite ivangura ryiza hagati yabarwayi bafite kandi badafite amateka yo kunanirwa k'umutima (agace kari munsi yabakiriye ikora umurongo wa 0.846 (0.830 kugeza 0.862) na 0.925 (0.919 kugeza 0.932), hamwe na Brier amanota 0.130 na 0.099, uko bikurikirana).).Ku barwayi batabanje kunanirwa k'umutima, kwisuzumisha byahoraga mu matsinda yose afite amahirwe make ya 40.3% (2502/6208) (agaciro keza ko guhanura 98.6%, 97.8% kugeza 99.1%) na 28.0% (1737/6208) birashoboka ko kunanirwa k'umutima gukabije byari hejuru (agaciro keza ko guhanura 75.0%, 65.7% kugeza 82.5%).
Umwanzuro Mu isuzumabumenyi mpuzamahanga ryakozwe ryerekana imikorere ya NT-proBNP, ibipimo byateganijwe mu mabwiriza yo gusuzuma indwara z'umutima ukabije byari bitandukanye cyane mu matsinda akomeye y'abarwayi.Igikoresho cyo Gushyigikira Icyemezo cya CoDE-HF gihuza NT-proBNP mubipimo bikomeza hamwe nizindi mpinduka zamavuriro, zitanga uburyo bunoze, bwuzuye kandi bwihariye.
Abantu bagera kuri miliyoni 1 mu Bwongereza bafite ikibazo cyo kunanirwa k'umutima kandi biteganijwe ko ubwiyongere bwiyongera hafi 50% mu myaka 25 iri imbere kubera abaturage basaza.1 Kwangirika k'umutima bikabije bingana na 5% mubitaro byose bitateganijwe.2 Gusuzuma neza kandi mugihe cyo kunanirwa k'umutima birashobora kuba ingorabahizi, kandi amabwiriza yigihugu ndetse n’amahanga arasaba kwipimisha peptide natriuretic kugirango ifashe mugupima.34.Ubushakashatsi bukora iperereza ku mikorere yo gusuzuma indwara ya NT-proBNP bwakorewe ahanini mu matsinda mato mato yatoranijwe y’abarwayi, ibyo bikaba bigabanya ubushobozi bwo guhuza ibisubizo mu matsinda mato akomeye, nk'abarwayi bageze mu zabukuru n'abarwayi bafite ikibazo cy'impyiko cyangwa umubyibuho ukabije, aho ibyo biranga bitandukanye byiza.bigenda bigaragara cyane ku barwayi bafite ikibazo cyo kunanirwa k'umutima.91011 Uburyo bwo kwerekana ibarurishamibare bwita kubiranga abarwayi kugirango batange igereranyo cyihariye gishobora kugira imikorere ihamye yo gusuzuma mubice byabarwayi.12
Nubwo hari moderi nyinshi zakozwe kugirango hamenyekane prognoza kubarwayi bafite ikibazo cyumutima, moderi nke zirashobora gufasha gusuzuma indwara yumutima ikabije.13141516171819 Ibigeragezo byabanje byagize ibyiza byinshi ariko birimo impinduka zifatika nkibishobora kuba abaganga mbere yo kwipimisha cyangwa abarwayi basobanura ibimenyetso.Mubyongeyeho, bashizemo NT-proBNP nkibihinduka bibiri kandi ntibitaye kumikoranire yingirakamaro kandi itari umurongo hagati ya NT-proBNP nizindi mpinduka zamavuriro.Ibigeragezo byabanje kugerageza guteza imbere no kwemeza umunzani wo kwisuzumisha byashyizwemo kandi umubare muto w'abarwayi bava mu kigo kimwe, cyabuzaga gusuzuma imikorere mu matsinda mato kandi bikagabanya amahirwe yo kuba rusange.
Muri iri sesengura mpuzamahanga rifatanije, twasuzumye imikorere yo gusuzuma umurongo ngenderwaho 'wasabwe na NT-proBNP ntarengwa yo kunanirwa k'umutima ukabije mu gice cy'abarwayi.Nyuma, twateje imbere kandi twemeza igikoresho cyo gufata ibyemezo kubarwayi bakekwaho kunanirwa k'umutima bakoresheje urugero rwibarurishamibare kugirango bahuze ibitekerezo bya NT-proBNP nibiranga ivuriro.
Twakoze isuzuma rifatika kugirango tumenye ubushakashatsi bwerekana imikorere yo gusuzuma indwara ya NT-proBNP ku barwayi bafite ikibazo cyo kunanirwa k'umutima.Twahinduye isubiramo ryabanje gukorwa na Roberts et al1 kugirango dushyiremo ijambo ryibanze "kunanirwa k'umutima" na "natriuretic peptide" dushakisha Embase, Medline, hamwe na Cochrane Central Register of Trials Controlles for titre and abstract byasohotse ku ya 18 Kanama 2021 (Inyandiko y'inyongera 1) .Ubushakashatsi bwafatwaga nk'ujuje ibisabwa niba bujuje ibi bikurikira byateganijwe mbere yo kwinjizwa: kwandikisha abarwayi bafite imyaka 18 y'amavuko bakekwaho kunanirwa k'umutima mu bihe byihutirwa, gupima NT-proBNP mu byitegererezo by'amaraso byabonetse mu isuzuma rya mbere ry'umurwayi ku munsi wo kwinjira, no gusuzuma indwara yumutima ikaze yakozwe hifashishijwe ibipimo byemewe.Abashakashatsi babiri (KKL na MA) basuzumye mu bwigenge ubushakashatsi bwose bwerekanwe no gushakisha ubuvanganzo butunganijwe, naho uwa gatatu (NLM) afata icyemezo cy'amakimbirane akoresheje protocole yagenwe mbere (igitabo cya PROSPERO: CRD42019159407).
Twahamagaye abanditsi babishinzwe kugirango abantu bose bujuje ibisabwa basabe amakuru kubyerekeranye na NT-proBNP, twemeza ko hasuzumwe ikibazo cyo kunanirwa k'umutima ukabije, demografiya (imyaka, igitsina, ubwoko), amateka yabanjirije (kunanirwa k'umutima, indwara zifata imitsi, urwego rw'abarwayi batamenyekanye).amakuru kuri diyabete), hypertension, hyperlipidemiya, kunywa itabi, asima, indwara zidakira zifata ibihaha, indwara zimpyiko zidakira), ibipimo bya physiologique (umuvuduko wumutima hamwe n umuvuduko wamaraso) mugupima kwambere, ivuriro rya haematologiya na biohimiki.Twagenzuye hamwe nabanditsi bose bireba kugirango tumenye neza, ibisobanuro byibihinduka, kandi byuzuye mbere yamasezerano.Ubushakashatsi bwose bwakozwe hakurikijwe Itangazo rya Helsinki kandi ryemejwe mu rwego rwo kwemerera gusangira amakuru ku rwego rw’abarwayi ku giti cyabo kuri iri sesengura.Abashakashatsi babiri (KKL na MA) basuzumye ubwigenge ingaruka zo kubogama kuri buri nyigo bakoresheje igikoresho cyo gusuzuma ubuziranenge bwo Kwiga mu Gusuzuma neza, verisiyo ya 2 (QUADAS-2), kandi amakimbirane 20 yakemuwe n’undi muntu (NLM).
Twakuye meta-igereranya hamwe 95% byizere intera yigihe cyo kwiyumvisha ibintu, umwihariko, agaciro keza ko guhanura, hamwe nagaciro keza ko guhanura umurongo ngenderwaho wasabye NT-proBNP kurenga (300 pg / mL) 58 hamwe nimyaka yihariye igenwa ( 450, 900, na 1800 pg / mL ku barwayi bafite imyaka <50, 50-75, na> imyaka 75) muburyo bwa binomial-busanzwe ingaruka zidasanzwe dukoresheje uburyo bwa DerSimoniya na Laird.21 Twongeye gusuzuma imikorere yibi byiciro mumatsinda mato yabanje gutondekanya imyaka, igitsina, ubwoko, indangagaciro z'umubiri, imikorere yimpyiko, kubura amaraso, no kuba ahari comorbidities (kunanirwa k'umutima, hypertension, hyperlipidaemia, diabete mellitus, fibrillation atriel, indwara idakira idakira). 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> 75летв 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 гипер пен кон, гиперлипидемия, сахарный диабет, мерцательная аритмия, хроническая об обитинная болезны лейких).我们 对 指南 的 NT-proBNP 排除 阈 值 (300 pg / mL) 58 和 年龄 特定 的 排除 阈 对于 (对于 年龄 <50、50-75 和> 75 岁 的 患者 ， 急性 心力衰竭 分别 、 450、900 和 1800 pg / mL) 7 ， 采用 两 阶段 方法 ， 在 每项 中 使用 使用 DerSimoniya 和 Laird 方法 的 二项式 正 态 随机 效应。。。。 这些 阈按 年龄 、 性别 、 、 体重 体重 、 肾 功能 、 贫血 心力衰竭 高血压 、 高脂 血症 糖尿病 、 心房颤动 、。。。。我们 对 指南 的 nt-probnp 排除 阈 值 (300 пг / ھى) 58 和 特定 的 排除 阈 值 阈 (对于 年龄 <50、50-75 和> 75 岁) 7 ， 采用 阶段 方法 ， 在 每 研究 中 分别 计算 估计 汇总 在 使用。。。。。。。。。。。。评估 按 年龄 性别 、 、 体重 体重 、 肾 功能 、 和 衰竭 高 血压 高脂 血症 糖尿病 心 房 颤动 。。。。 。。。。 。。。。 。。。。使用 方法 方法 我们 随后 评估 了 nt-probnp 浓度 一系列 浓度 范围 的 诊断 性能 性能 ， 排除 阈 值 ， 比例 的 患者 具有 98 98 98 ≥ ≥ 98% ≥ 75%。
Twabaze agaciro (0-100) gahuye nibishoboka byo kurwara umutima ukabije kumurwayi kugiti cye dukoresheje icyitegererezo cyibarurishamibare.Bitewe nuko itandukaniro rigaragara ryiganje ryubwiyongere bukabije hamwe no kunanirwa k'umutima, twateje imbere kandi twemeza icyitegererezo kubarwayi bafite ikibazo cyo kunanirwa k'umutima.Twifashishije intumbero ya NT-proBNP nkigipimo gihoraho kandi twahisemo ibintu byoroheje byamavuriro bizwi ko bifitanye isano no kunanirwa k'umutima byari bifite akamaro kanini cyane mugihe cyamahugurwa yicyitegererezo cyacu (imyaka, igipimo cyo kuyungurura isi, gemoglobine, umubiri rusange )., umuvuduko wumutima, umuvuduko wamaraso, edema periferique, indwara zidakira zifata ibihaha nindwara yumutima ischemic) (Inyandiko yinyongera 2).
Mugutezimbere Code-HF, twasuzumye uburyo bune butandukanye bwibarurishamibare: Rusange Rusange Ivanze Moderi, Naive Bayes, Ishyamba Ryiza, na Gradient Ikabije (XGBoost) (Inyandiko yinyongera 2).222324 Kugirango tubare amakuru yabuze mubushakashatsi (Igicapo c'inyongera A), twagwije imibare 10 yatanzwe dukoresheje uburyo bwo guhuriza hamwe uburyo butandukanye hamwe na materix ya covariance yatoranijwe ihuye na algorithm ya Monte Carlo Markov.25 Twakoze imputasi nyinshi kubihinduka byose bikubiye murugero usibye NT-proBNP.Twakoze ibisubiramo 10 byikubye inshuro 10 kuri buri cyitegererezo kandi dukoresha ikigereranyo cyo hagati ya itera kandi dushyizeho imibare nkuko imibare ya CoDE-HF kuri buri murwayi.Icyakurikiyeho, twabonye amanota yashyize mubice byinshi byabarwayi bafite amahirwe menshi cyangwa make yo kunanirwa k'umutima ukabije, hamwe nibikorwa byiza byo guhezwa (75% agaciro keza ko guhanura na 90% byihariye) no kubirengagiza (98% agaciro kateganijwe na 90% % yihariye)% sensitivite) muburyo bukomeye bwo kunanirwa k'umutima.
Twasuzumye imikorere ya buri cyitegererezo ku bipimo bitandukanye byo kwisuzumisha (agace kari munsi yumurongo wakira, umurongo wa Brier, igipimo cy’abarwayi bagera ku bipimo byiza kandi bito bishoboka, hamwe n’indangagaciro nziza kandi mbi yo guhanura amatsinda y’abarwayi).Amanota ya Brier ni ivangura na kalibrasi ibarwa mu gufata ikosa risanzwe hagati yimiterere iteganijwe no kwitegereza.26 Twahisemo icyitegererezo cyiza kubikoresho bifasha ibyemezo bya Code-HF.Turasuzuma imikorere ya CoDE-HF dukoresheje gusesengura ibyemezo byo gusesengura no imbere no hanze byambukiranya.Muri make, ubu buryo bwirengagije byimazeyo ubushakashatsi bumwe icyarimwe kugirango bwemeze hanze kandi bukoresha ubushakashatsi busigaye mugutezimbere icyitegererezo.27 Ntabwo twinjije indangagaciro mumibare yemewe yo hanze bityo ntitwigeze twemeza hanze kubushakashatsi bwinshi.Impinduka ntiyari ihari rwose (Ishusho yinyongera A).Twakoresheje R verisiyo 4.1.2 kubisesengura byose.
Abarwayi n'abagize komisiyo ya Leta bagize uruhare mu gusobanura ibisubizo.Hariho gahunda yo gukwirakwiza ibisubizo kumuryango wabarwayi bireba.
Twaganiriye n'abashakashatsi baturutse mu bushakashatsi 30 bujuje ibisabwa, muri bo 19 barashubije.Ubushakashatsi cumi na bine (ubushakashatsi 12 buteganijwe bwa cohort hamwe n’ibigeragezo bibiri byateganijwe) byatanze amakuru ku rwego rw’abarwayi kuva ku barwayi 10 kugeza kuri 369 bafite ikibazo cy’umutima ukabije (bivuze imyaka 69.3; abagabo 53.3%) baturutse mu bihugu 13 (Imbonerahamwe 1).Igishushanyo B;Imbonerahamwe yinyongera A na B) 1528293031323334353637383940 Ubushakashatsi bwose bwakorewe mu ishami ry’ubutabazi, usibye ubushakashatsi bumwe bwarimo abarwayi b’umutima n’ibihaha (bivuze abarwayi 488 kuri buri nyigo (quartile. Bitandukanya 322-103)).Muri rusange, 43.9% (4549 / 10,369) by’abarwayi bafite isuzuma ryemeza ko ryananiwe umutima (ubushakashatsi bwakozwe hagati ya 46% (31-54%)).Ku barwayi bafite ikibazo cyo kunanirwa k'umutima mbere, ikibazo cyo kunanirwa k'umutima cyari kinini ugereranije no ku barwayi badafite umutima (73.3% (2286/3119) na 29.0% (1802/6208)) (Imbonerahamwe y'inyongera C).
Ibyingenzi biranga abarwayi batandukanijwe no gusuzuma indwara yumutima ukabije.Indangagaciro ni imibare (ijanisha) keretse bivuzwe ukundi
Ku murongo ngenderwaho wasabwe kurenga 300 pg / mL, ihuriweho na meta-kugereranya agaciro keza ko guhanura, kumva, agaciro keza ko guhanura, hamwe na NT-proBNP mubaturage muri rusange byari 94,6% (95% intera y'icyizere, 91.9%) .kugeza kuri 96.4%), 96.8% (kuva kuri 94,6% kugeza kuri 98.1%), 62.9% (kuva 51.3% kugeza 73.3%) na 49.3% (kuva 35.4% kugeza kuri 63.4%) (Ishusho 1; Imbonerahamwe yinyongera D).Muri rusange, 30.4% (3148 / 10,369) y’abarwayi bafite NT-proBNP iri munsi ya 300 pg / mL.Nyamara, hagaragaye ubudasa hagati yitsinda ryabarwayi nubushakashatsi (Ishusho 2; Ishusho 3; Imibare yinyongera C na D).Indangagaciro mbi zo guhanura zaragabanutse ku barwayi bafite imyaka 75 (88.2%, kuva kuri 83.5% kugeza kuri 91.8%), ndetse no ku barwayi bafite amateka yo kunanirwa k'umutima (79.4%, kuva kuri 68.4% kugeza kuri 87.3%) n'umubyibuho ukabije. (90.4%, kuva 84.5% kugeza 87.3%).94.2%.
N-terminal ntarengwa ya pro-B yo mu bwoko bwa natriuretic peptide (NT-proBNP) mu kunanirwa k'umutima.Hejuru ibumoso: Agaciro keza ko guhanura kwa NT-proBNP kugirango wirinde gusuzuma indwara zananiranye z'umutima.Hepfo ibumoso: Umubare w'abarwayi bafite ikibazo cyo kunanirwa k'umutima ukabije hamwe na NT-proBNP yibanze munsi ya buri rugi.Hejuru iburyo: Agaciro keza ko guhanura NT-proBNP kwibanda ku gusuzuma indwara ikabije y'umutima.Hepfo iburyo: Umubare w'abarwayi bafite ikibazo cyo kunanirwa k'umutima ukabije hamwe na NT-proBNP yibanda kuri buri rugi.
Gusuzuma imikorere yubuyobozi-busabwa N-itumanaho ntarengwa ya por-B yo mu bwoko bwa natriuretic peptide mu matsinda y’abarwayi: agaciro kateganijwe kateganijwe kuri 300 pg / mL.COPD = indwara idakira ifata ibihaha;eGFR = igereranyo cya glomerular igipimo
Imikorere yo gusuzuma umurongo ngenderwaho wasabye NT-proBNP kurenga kumatsinda yabarwayi: agaciro keza ko guhanura imyaka ntarengwa kumatsinda yabarwayi (450, 900, na 1800 pg / mL kuri <50, 50-75, na> imyaka 75). Imikorere yo gusuzuma umurongo ngenderwaho wasabye NT-proBNP kurenga kumatsinda yabarwayi: agaciro keza ko guhanura imyaka ntarengwa kumatsinda yabarwayi (450, 900, na 1800 pg / mL kuri <50, 50-75, na> imyaka 75). Ди нагостическая уность ромом Канованных в руководстве порогов NT-proBNP для подгру новов: положительная прогностическая ценность возрастных порогов для подгпа кнов (450, 900 и 1800 пг Gusuzuma imikorere yubuyobozi-busabwa na NT-proBNP imbago zitsinda ryitsinda ryabarwayi: agaciro keza ko guhanura imyaka yihariye yumubare w'abarwayi (450, 900, na 1800 pg / mL kuri <50, 50-75, na> imyaka 75,) .指南 推荐 的 患者 患者 亚 组 的 NT-proBNP 阈 值 的 诊断 性能 ： 跨 患者 亚 组 为 为 为 为 为 为 、 450、900 和 1800 pg / mL ， <50、50-75 和> 75岁）。指南 推荐 的 跨 患者-nt-Probnp 阈 值 的 性能 ： 跨 亚 组 的 为 为 、 、 、 、 、 、 450、900 和 1800 pg / ml ， <50、50-75 和> 75 岁）。 Ди нагостическая барность порогов NT-proBNP, ромом Канованных руководством, для подгру минов: положительная прогностическая ценность возрастных порогов для подгпа снов (450, 900 и 1800 пог / вот) Gusuzuma imikorere yubuyobozi-busabwa NT-proBNP imbago zitsinda ryitsinda ry’abarwayi: agaciro keza ko guhanura imyaka ntarengwa y’imipaka y’abarwayi (450, 900, na 1800 pg / mL, <50, 50-75, na> 75, uko imyaka ikurikirana ).COPD = indwara idakira ifata ibihaha;eGFR = igereranyo cya glomerular igipimo
Ikigereranyo cya meta-igereranyo cyerekana agaciro keza ko guhanura imyaka kugabanya imyaka ya NT-proBNP 450, 900, na 1800 pg / mL byari 61.0% (55.3% kugeza 66.4%), 73.5% (62.3% kugeza 82. 3%) na 80.2%, (70.9% kugeza 87.1%) (Imbonerahamwe 2).Ibisobanuro bihuye byari 87.8% (79.5% kugeza 93.0%), 81.1% (72,6% kugeza 87.5%), na 73.1% (65.2% kugeza 79. umunani%).Muri rusange, 48.7% (5052 / 10,369) by’abarwayi bafite ikibazo cy’umutima ukabije bafite NT-proBNP hejuru y’imyaka.Nuburyo butandukanye mubyiciro byimyaka, imikorere yimpyiko, hamwe nubwinshi bwumutima ukabije wumutima, mumatsinda mato, kugabanya imyaka y'amategeko byari bifite indangagaciro nziza zo guhanura hejuru yo gukata 300 pg / mL (Ishusho yinyongera EI) .
Imikorere yo gusuzuma ya N-terminal B ubwoko bwa natriuretic peptide precursor (NT-proBNP) imyaka ntarengwa yo kunanirwa k'umutima ukabije
Muri rusange, twabonye ubushakashatsi burindwi bufite ibyago byinshi byo kubogama (Imbonerahamwe yinyongera A).Mu gusesengura ibyiyumvo bigarukira gusa ku bushakashatsi bwahumye amaso NT-proBNP kugira ngo hamenyekane ikibazo cyo kunanirwa k'umutima ndetse n'ubushakashatsi bufite ibyago bike byo kubogama, umurongo ngenderwaho 'wasabye ibimenyetso byo gusuzuma no kugabanya imyaka kuri NT-proBNP ntiwahindutse (Imbonerahamwe y'inyongera E na F )..
Urutonde rwa 100 pg / mL NT-proBNP rwujuje ibisabwa byiza byo guhezwa hamwe hamwe n’agaciro kateganijwe hamwe kangana na 97.8% (intera 95.8% kugeza 98.8%) hamwe na sensibilité ya 99.3% (intera 98.5% kugeza 99.7%) (Imbonerahamwe yinyongera D) .Nyamara, 17.9% gusa (1851/10 ~ 369) byabarwayi bari bafite intumbero ya NT-proBNP iri munsi ya 100 pg / mL, kandi bari babi kubarwayi bageze mu zabukuru n’abarwayi bafite ikibazo cy’umutima, indwara zifata imitsi, hamwe n’amateka y’imivurungano Ubuhanuzi bukomeje kuba bubi. ..Imikorere y'impyiko (Ishusho yinyongera J).Mu buryo nk'ubwo, 1000 pg / mL NT-proBNP yaciwe yujuje ibisabwa byiza byo gusuzuma hamwe nagaciro keza ko guhanura kangana na 74.9% (64.4% kugeza 83.2%) kandi umwihariko wa 76.1% (65.6% kugeza 84.2%).yari hasi.Itandukaniro.Yagabanutse kandi mumatsinda mato y'abarwayi, cyane cyane abadafite amateka yambere yo kunanirwa k'umutima (agaciro keza ko guhanura 62%, 41% kugeza 79%) (Imbonerahamwe yinyongera D; Ishusho yinyongera K).
Icyitegererezo gikabije cyo kuzamura (XGBoost) hamwe nicyitegererezo rusange kivanze nicyitegererezo cyakozwe neza (agace kari munsi yumurongo mugice rusange cyamahugurwa 0.925 (95% CI 0.919 kugeza 0.932) na 0.931 (0.925 kugeza 0.937), () Inyandiko 2).Nubwo imikorere ya XGBoost isa na moderi rusange ivanze yerekana imiterere, inyungu nyamukuru ya XGBoost nubushobozi bwayo bwo kubara amanota mugihe habuze agaciro.Iki nikintu cyingenzi twizera ko tuzashyira mubikorwa mugikoresho cyo gushyigikira ibyemezo bya CoDE-HF kugirango byoroherezwe kuyishyira mubikorwa byubuvuzi, niyo mpamvu twahisemo icyitegererezo cya XGBoost nkicyitegererezo cyanyuma kuri CoDE-HF.
CoDE-HF yahinduwe neza kandi yari ifite ivangura ryiza kubarwayi bafite ikibazo cyo kunanirwa k'umutima (agace kari munsi yumurongo wakira 0.846 (0.830 kugeza 0.862) na 0.925 (0.919 kugeza 0.932) hamwe na Brier amanota 0.130 na 0.130).0.099) (Ishusho 4; Igishushanyo cy'inyongera L).Amanota ya CoDE-HF ya 4.7 atanga agaciro keza ko guhanura kangana na 98.6% (97.8% kugeza 99.1%) hamwe na sensibilité ya 98.1% (96.9% kugeza 98.9%) (Imbonerahamwe yinyongera G), naho amanota 51.2 atanga ibipimo byiza byo guhanura agaciro.agaciro 75.0% (65.7%) 82.5%), umwihariko wari 92.2% (87.5% kugeza 95.2%) byabarwayi badafite amateka yo kunanirwa k'umutima.Ibipimo byo kwinjiza no guhezwa byari bifite imikorere isa yo gusuzuma mu matsinda yose (Ishusho 5, Ishusho 6, Ishusho 7). Niba aya manota yarakoreshejwe mubarwayi bakekwaho kunanirwa k'umutima, CoDE-HF yagaragaza 40.3% (2502/6208) bishoboka cyane (<4.7) na 28.0% (1737/6208) bishoboka cyane (â € ¥ 51.2) ya kunanirwa k'umutima. Niba aya manota yarakoreshejwe mubarwayi bakekwaho kunanirwa k'umutima, CoDE-HF yagaragaza 40.3% (2502/6208) bishoboka cyane (<4.7) na 28.0% (1737/6208) bishoboka cyane (â € ¥ 51.2) ya kunanirwa k'umutima. Если бы эти показатели применялись к كانентам с подозрением на острую сердечную недостаточность, CoDE-HF вявил бы 40,3% (2502/6208) при низкой вероятности (<4,7) и 28,0% (≥51,2) сердечной недостаточности. Niba ibi bipimo byarakoreshejwe ku barwayi bafite ikibazo cy’umutima ukabije, CoDE-HF yamenya 40.3% (2502/6208) ifite amahirwe make (<4.7) na 28.0% (1737/6208) ifite umutima mwinshi (≥51.2) gutsindwa.kunanirwa k'umutima.如果 将 这些 评分 应用于 急性 心力衰竭 的 患者 ， CoDE-HF 将 识别 出 3 40.3% (2502/6208) 的 低 概率 (<4.7) 和 28.0% (1737/6208) 的 高 概率 (≥51.2) 急性 心力。。如果 将 这些 评分 应用 于 ， 衰竭 衰竭 ， ， code-hf 识别 出 出 40.3% (2502/6208) 的 低 概率 概率 <(<4.7) 和 28.0% (1737/6208) 的 高 概率 高 概率 (≥51.2 ) 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。。。 Если бы эти оценки применялись к kенентам с подозрением на острую сердечную недостаточность, CoDE-HF вявил бы 40,3% (2502/6208) низкой вероятности (<4,7) и 28,0% (37 8) 51,2) острой сердечной недостаточности. Niba aya manota yarakoreshejwe kubarwayi bafite ikibazo cyo kunanirwa k'umutima, CoDE-HF yagaragaza 40.3% (2502/6208) bishoboka cyane (<4.7) na 28.0% (1737/6208) bishoboka cyane (≥ 51.2) kunanirwa k'umutima.umunaniro.Mu barwayi bafite ikibazo cyo kunanirwa k'umutima mbere, nta n'amanota yatanzwe mu itsinda ryujuje ibisabwa kugira ngo twirinde.Amanota ya CoDE-HF yari 84.5, agaciro keza ko guhanura kari 92.7% (89.1% kugeza 95.2%), naho umwihariko wari 90.2% (84.0% kugeza 94.1%).Iri suzuma rizagaragaza 45.5% (1420/3119) by’abarwayi bafite amahirwe menshi yo kurwara umutima ukabije (Ishusho 8).Mu isesengura ry'imyanzuro yo gufata ibyemezo byose bishoboka, CoDE-HF yari ifite inyungu nyinshi kurenza NT-proBNP yonyine (Ishusho yinyongera M).Amanota ya CoDE-HF yagabanutseho gato nta mateka yo guhugura (agace kari munsi yumurongo wakira yakira ni 0.922 (0.916 kugeza 0.929) na 0.841 (0.825 kugeza 0.825 kubarwayi badafite umutima utananirwa no kubura umutima) 0.857).Imbere n’inyuma-kwambukiranya byakozwe neza muri cohort yuburyo bubiri (Ishusho yinyongera N).
Igipimo cyo Gusuzuma no Gusuzuma Umutima (CoDE-HF) cyahinduwe ku kigereranyo cy’abarwayi bafite ikibazo cyo kunanirwa k'umutima.Umurongo utudomo werekana kalibrasi nziza.Buri ngingo ihuye n'abarwayi 100.Hejuru: Calibibasi ya CoDE-HF kumurwayi utabanje kunanirwa k'umutima.Hasi: Calibibasi ya CoDE-HF kumurwayi ufite amateka yo kunanirwa k'umutima.
Imikorere yo gusuzuma imikorere yumutima kunanirwa gufatanya gusuzuma no gusuzuma igipimo (CoDE-HF) mumatsinda mato y'abarwayi.Amanota yo guhezwa ya CoDE-HF yari afite agaciro keza ko guhanura 4.7 mu itsinda ry’abarwayi badafite amateka yo kunanirwa k'umutima.CoDE-HF ikoresha N-terminal natriuretic peptide yo mu bwoko bwa B ibanziriza kwibanda nkibipimo bikomeza kandi byateganijwe mbere na mbere ibintu byoroheje byahinduwe (imyaka, igipimo cyo kuyungurura isi) Indwara y'ibihaha (COPD) n'indwara z'umutima zifata umutima) itanga isuzuma ryumuntu ku giti cye bishoboka ko hasuzumwa ikibazo cyo kunanirwa k'umutima ukabije.
Imikorere yo gusuzuma igipimo cya CoDE-HF ku bufatanye bwo gusuzuma no gusuzuma igipimo cyo kunanirwa k'umutima mu matsinda y'abarwayi.Amanota ya CoDE-HF yari afite agaciro keza ko guhanura 51.2 mumatsinda yabarwayi badafite amateka yo kunanirwa k'umutima.CoDE-HF yahujije intumbero ya NT-proBNP nk'ibipimo bikomeza kandi byateganijwe mbere y'ibihinduka byoroheje bivura (imyaka, igipimo cyo kuyungurura isi (eGFR), hemoglobine, igipimo cy'umubiri, umuvuduko w'amaraso, umuvuduko w'amaraso, indurwe ya periferique, indwara zidakira zifata ibihaha (COPD) ).indwara ya coronary arteriire) itanga isuzuma ryumuntu ku giti cye bishoboka ko hasuzumwa ikibazo cyo kunanirwa k'umutima
Imikorere yo gusuzuma Ubufatanye bwo Gusuzuma no Gusuzuma Kunanirwa k'umutima (CoDE-HF) mu matsinda mato y'abarwayi.Amanota ya CoDE-HF yari afite agaciro keza ko guhanura 84.5 kubarwayi bafite amateka yo kunanirwa k'umutima mu itsinda ry'abarwayi.CoDE-HF yahujije intumbero ya NT-proBNP nk'ibipimo bikomeza kandi byateganijwe mbere y'ibihinduka byoroheje bivura (imyaka, igipimo cyo kuyungurura isi (eGFR), hemoglobine, igipimo cy'umubiri, umuvuduko w'amaraso, umuvuduko w'amaraso, indurwe ya periferique, indwara zidakira zifata ibihaha (COPD) ).indwara ya coronary arteriire) itanga isuzuma ryumuntu ku giti cye bishoboka ko hasuzumwa ikibazo cyo kunanirwa k'umutima
Igipimo cyo kunanirwa k'umutima hamwe no gusuzuma igipimo (CoDE-HF) ntabwo gisuzumwa neza kubarwayi bafite amateka yo kunanirwa k'umutima.Hejuru: Indangagaciro mbi kandi nziza zo guhanura amanota ya CoDE-HF.Umurongo wubururu wubururu utudomo werekana amanota yo gukuraho intego ya 4.7.Umurongo utukura utudomo werekana amanota agenga amanota 51.2.Hasi: ikarita yubucucike bwamanota ya CoDE-HF kubarwayi badafite amateka yo kunanirwa k'umutima.Intego zo guhezwa no gutegeka zagaragaje 40.3% by’abarwayi bafite amahirwe make na 28.0% bafite amahirwe menshi.
Abarwayi bagaragajwe ko bishoboka cyane na CoDE-HF bagabanutse cyane impfu zose zatewe na CV muminsi 30 numwaka 1 ugereranije n’abarwayi bagaragaye ko ari intera ndende kandi ishobora kuba myinshi (iminsi 30 y’impfu zose: 1. 0% ugereranije na 4.0 % na 10.4%).impfu zatewe n'impamvu zose mugihe cyumwaka umwe: 5.9% na 17.8% na 33.4%;Impfu z'iminsi 30 zatewe n'indwara z'umutima: 0.2% na 0.8% na 4.1%;impfu z'umwaka ziterwa n'indwara z'umutima-damura: 1.4% na 3.4% na 16.3%) (Ishusho 9). Ku barwayi bafite NT-proBNP yibanze <300 pg / mL ugereranije n’izo â € ¥ 300 pg / mL, zose zitera impfu zabaye 0.8% na 7,6% mu minsi 30 na 5.9% na 26.6% mu mwaka umwe, kandi, ibipimo by'imfu z'umutima n'imitsi byari 0.1% na 2,6% muminsi 30 na 1,3% na 10.2% kumwaka umwe, (imbonerahamwe yinyongera H; igishushanyo O). Ku barwayi bafite NT-proBNP yibanze <300 pg / mL ugereranije n’izo â € ¥ 300 pg / mL, zose zitera impfu zabaye 0.8% na 7,6% mu minsi 30 na 5.9% na 26.6% mu mwaka umwe, kandi, ibipimo by'imfu z'umutima n'imitsi byari 0.1% na 2,6% muminsi 30 na 1,3% na 10.2% kumwaka umwe, (imbonerahamwe yinyongera H; igishushanyo O). У тановов с % 6 H; дополнительный рисунок O). Ku barwayi bafite intumbero ya NT-proBNP <300 pg / ml ugereranije nu munsi ya 300 pg / ml, impfu zose zatewe na 0.8% ugereranije na 7,6% muminsi 30 na 5.9% ugereranije na 26, 6% kumwaka umwe. , na CV bipfa byari 0.1% na 2,6% muminsi 30 na 1,3% na 10.2% kumwaka umwe, (Imbonerahamwe yinyongera H; Ishusho yinyongera 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% 和 7,6% ，死亡率 在 30 天时 分别 为 0.1% 和 2,6% ， 一年 时 分别 为 1.3% 和 10.2% （补充 表 H ； 补充 图 O）。 NT-IKIBAZO 浓度 <300 pg / ml 的 与 ≥ ≥300 pg / ml 的 相比 ， ， 30 天全 因 分别 为 为 为 0.8% 和 7,6% ，血管 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 在 在 在 天时 在 在 在 30 天时 分别 为 0.1% 和 2.6% ， 。。 Паци с с года, а также сердечно-соудидистую смертность. Abarwayi bafite intumbero ya NT-proBNP <300 pg / mL ugereranije na 00300 pg / mL bafite iminsi 30 yimpamvu zose zatewe na 0.8% na 7,6%, 5.9% na 26,6% mugihe cyumwaka umwe, nimpfu zumutima.bari 0.1% na 2,6% muminsi 30 na 1.3% na 10.2% kumwaka 1 (Imbonerahamwe yinyongera H; Ishusho yinyongera O).
Igiteranyo cyimpamvu zose ziterwa nimpfu zashyizwe mubikorwa na Gufatanya mugusuzuma no gusuzuma ikibazo cyo kunanirwa k'umutima (CoDE-HF) itsinda rishoboka
Twakoze meta-gusesengura amakuru ku rwego rw’abarwayi ku giti cyabo kugira ngo dusuzume imikorere yo gusuzuma indwara ya NT-proBNP ku barwayi barenga 10 bakekwaho kuba bafite ikibazo cy’umutima ukabije yashyizwe mu bushakashatsi 14 buteganijwe kuva mu bihugu 13 twateguye kandi dushyira mu bikorwa dukoresheje NT-proBNP.proBNP nkigikoresho cyo gufata ibyemezo cyo gukomeza gupima.Turatanga raporo nyinshi zingenzi.Ubwa mbere, umurongo ngenderwaho wasabwe kurenza urugero kugirango ukureho kunanirwa k'umutima ntago ari kimwe mumatsinda akomeye y'abarwayi.3 Nubwo abaturage muri rusange hamwe nitsinda rito, harimo abarwayi n’abagore bakiri bato, bitwaye neza, abarwayi bakuze n’abagore bari bafite agaciro keza ko guhanura.Ku barwayi bafite umubyibuho ukabije cyangwa kunanirwa k'umutima mbere, igipimo kibi cyibinyoma cyatandukanijwe kuva kuri icumi kugeza kuri umwe kuri batanu.Icya kabiri, ibipimo byerekana imyaka byagaragaye neza mugupima ikibazo cyo kunanirwa k'umutima.Nyamara, agaciro keza ko guhanura kari hasi kubarwayi bakiri bato.Icya gatatu, nubwo NT-proBNP yatunganijwe neza ya 100 pg / mL kugirango twirinde kunanirwa k'umutima ukabije na 1000 pg / mL gutegeka kunanirwa k'umutima bifite agaciro keza kandi keza ko guhanura mubaturage muri rusange, abarwayi bakuze bameze nabi .mu barwayi bafite ikibazo gikomeye cy'umutima.Kunanirwa k'umutima n'umubyibuho ukabije.Hanyuma, twateje imbere kandi twemeza igikoresho cyo gushyigikira ibyemezo, amanota ya CoDE-HF, hamwe nibikorwa byiza byo kwisuzumisha mumatsinda yose y'abarwayi.Iki gikoresho cyo gushyigikira ibyemezo cyakuweho kandi kirwanya kunanirwa gukabije k'umutima kurenza uburyo ubwo aribwo bwose ukoresheje gusa NT-proBNP.
Ku bumenyi bwacu, ubu ni ubushakashatsi bunini kugeza ubu busuzuma imikorere yo gusuzuma NT-proBNP mu kunanirwa k'umutima.Byose birimo ubushakashatsi byari byitezwe kandi isuzuma rya nyuma ryakozwe nitsinda ryabaganga bakoresheje amakuru yose ahari.Ni ngombwa kumenya ko kuboneka kwamakuru kurwego rwumurwayi ku giti cye mubantu benshi biga biga bituma habaho isuzuma ryizewe ryimikorere yo gusuzuma indwara zose zishoboka NT-proBNP yinjira mumatsinda yabarwayi, kimwe no guteza imbere no kwemeza umunzani mushya wo gusuzuma.
Amabwiriza menshi yigihugu ndetse n’amahanga arasaba gukoresha NT-proBNP igabanya agaciro ka 300 pg / mL kugirango hirindwe kunanirwa k'umutima58 hashingiwe ku bushakashatsi bwinshi bwabanjirije 3444142 butangaza ko agaciro kateganijwe kangana na 98% muri uku guhagarikwa.imikorere yo gusuzuma amatsinda mato yingenzi yabarwayi ntashobora gusuzumwa.Ubushakashatsi bwacu bwakoresheje abarwayi inshuro eshatu nk’ubushakashatsi bwakozwe ku rwego rwa mbere meta-analyse, 3 bwerekanye agaciro gake muri rusange ko guhanura kugabanijwe kuri 300 pg / mL hamwe na meta-igereranya 94.6%.Icy'ingenzi cyane, agaciro keza ko guhanura kari hasi cyane mumatsinda yingenzi nkabarwayi bageze mu zabukuru n’abarwayi bafite ikibazo cy’umutima cyabayeho mbere, indwara zifata imitsi, n’umubyibuho ukabije.Byongeye kandi, abarwayi bagera kuri 70% bari bafite intumbero ya NT-proBNP hejuru ya 300 pg / ml yaciwe, bagaragaza aho bagarukira gukoresha ingingo imwe yo guca mu bikorwa.Nubwo kugabanuka kwa 100 pg / mL byageze ku gipimo rusange cyo guhanura 98%, cyakoze nabi mu itsinda ry’abarwayi.Byongeye kandi, imyaka hamwe nuburyo bwiza bwo kunanirwa k'umutima byerekanaga itandukanyirizo mumatsinda mato y'abarwayi, cyane cyane mubadafite amateka yambere yo kunanirwa k'umutima.Uku gutandukana mubikorwa byo kwisuzumisha birahangayikishije cyane nkuko abaturage bacu barwayi basaza kandi bafite ingaruka nyinshi.Ibi bitera kwibaza niba umurongo ngenderwaho wamavuriro ugomba gukomeza gusaba ko hakoreshwa ibihano bimwe mugihe NT-proBNP yibasiwe nimpamvu nyinshi ziterwa ningaruka.
Kugirango tunoze akamaro kamavuriro ya NT-proBNP, twateje imbere kandi twemeza hanze isuzuma rya CoDE-HF ryigikoresho cyo gufata ibyemezo byubuvuzi.Aya manota ahuza NT-proBNP nkigipimo gikomeza hamwe nimpinduka zoroheje zifatika zo kwa muganga kugirango zitange isuzuma ryumuntu ku giti cye bishoboka ko hasuzumwa ikibazo cyo kunanirwa k'umutima ukabije.Twerekana ko imikorere yo gusuzuma amanota ya CoDE-HF ikomeye mumatsinda yabarwayi.CoDE-HF yashoboye kwirinda no kwirinda gusuzuma indwara zananiranye z'umutima ku mubare munini w'abarwayi kuruta urwego rwa NT-proBNP rwonyine.Byongeye kandi, mubisesengura ryicyemezo cyo gufata ibyemezo, twasanze CoDE-HF ifite inyungu nyinshi kurenza NT-proBNP yonyine, murwego rwose rushoboka.Twizera ko uyu mwanzuro utajenjetse kubera ko NT-proBNP ari ikimenyetso gihoraho cyerekana ingaruka kandi kwibanda kwayo biterwa nibindi bintu bifitanye isano n’umurwayi nk’ibipimo by’umubiri, imyaka, n'imikorere y'impyiko.434445 Mugihe ibi bipimo bishingiye kubipimo byateganijwe mbere, twemera ko izo ntego zishobora kudashyigikirwa na bose kandi ko ibigo nderabuzima bitandukanye bishobora kwihanganira ingaruka zitandukanye.Ibyiza byo gukoresha ibikoresho bifasha ibyemezo nka CoDE-HF nuko abaganga cyangwa ibigo bashobora guhitamo ibipimo ngenderwaho byo kwisuzumisha bizakoreshwa mugufatira ibyemezo byaho hashingiwe kubyo bashyira imbere no kuboneka kwa echocardiography cyangwa inzobere mu kunanirwa k'umutima..
Turateganya ko igikoresho cyacu gishya cyo gushyigikira ibyemezo, Code-HF, gishobora kunoza urwego rwabarwayi bafite ikibazo cy’umutima ukabije ugaragara mu buvuzi butandukanye kandi bagahindura ubuvuzi bwabo, bikaborohereza gusuzuma neza.Ubushakashatsi bwibanze bwerekanye ko kuvura ku gihe kandi neza bishingiye ku bimenyetso bifatika by’abarwayi bafite ikibazo cy’umutima bikabije bishobora kugabanya cyane imfu n’uburebure bw’ibitaro, kandi gutinda bifitanye isano n’ingaruka mbi.46 Byongeye kandi, bisanzwe byakusanyirijwe hamwe CoDE-HF ikoresha impinduka bityo irashobora kwinjizwa mubikorwa byubuvuzi nkigice cyinzira nyabagendwa ishinzwe ubutabazi kugirango isuzume neza.Kugeza ubu, umubare munini w'abarwayi bafite ikibazo cyo kunanirwa k'umutima bafite echocardiografi yo kwinjira kugira ngo bamenye imiti yabo, ariko amaherezo ni bo basuzumwa igice kimwe cy'abarwayi.2 Echocardiography nubushakashatsi butwara igihe kandi busaba imbaraga cyane Turateganya ko gukoresha CoDE-HF mugukoresha neza kandi neza gukoresha serivisi zihariye nka echocardiografiya bishobora kuganisha ku kuzigama amafaranga menshi no gukora neza muri sisitemu yubuzima..Byongeye kandi, kuzigama amafaranga birashobora kugerwaho hifashishijwe kuvura abarwayi bafite ibyago bike.Ubushakashatsi buteganijwe burakenewe muri iki gihe kugira ngo hamenyekane ivuriro n’igiciro cy’ibyemezo bitandukanye bya CoDE-HF mu bikorwa by’ubuvuzi.
Turemera aho tugarukira.Ubwa mbere, twashoboye kubona amakuru yumurwayi ku giti cye kuri 14 kuri 30 yubushakashatsi bwujuje ibyangombwa byujuje ibisabwa, bityo kubogama birashobora gutangizwa.Nyamara, ubushakashatsi bujuje ibisabwa butarimo bwari bwaragaragaye cyane nko kunanirwa k'umutima ukabije, amatariki yatangarijweho, ndetse no ku turere twavuzwe, kandi abaturage bari bafite imiterere y’imiterere n’ubuvuzi ku baturage barimo.Icya kabiri, mugihe amakuru yavuye mubushakashatsi bwinshi yahujwe, ubushakashatsi bumwe bwabuze amakuru kubintu bimwe bihinduka.Kugirango twongere gukoresha amakuru, twakoresheje uburyo bukurikirana bwo gutandukana.Icya gatatu, ntabwo twanditse ECG nigituza X-ray ikurikiranye kugirango tubishyire mubyitegererezo byacu.Gusobanura NT-proBNP ku barwayi bakekwaho kunanirwa k'umutima bigomba gukorwa bifatanije n’ubushakashatsi, 47 n’ubundi bushakashatsi burakenewe kugira ngo hamenyekane niba uburyo buhuza ubu bushakashatsi bushobora kuzamura amanota ya CoDE-HF.Icya kane, ntabwo ubushakashatsi bwose bwakoze kwisuzumisha utitaye kubisubizo byikizamini cya NT-proBNP.Mu isesengura ryibyiyumvo byacu, mugihe twakuyemo ubushakashatsi bubiri hamwe nubusobanuro butabujijwe, nta gihindutse mubikorwa byo gusuzuma.Icya gatanu, isuzumabumenyi ryagaragaye ryo kunanirwa k'umutima ntikwemereye gutandukanya kunanirwa k'umutima hamwe no kugabanuka kw'igice cyo gusohora no kunanirwa k'umutima hamwe n'igice cyo gusohora cyabitswe.Ubwiyongere bukabije bwa HF hamwe n’igice cyo gusohora cyabitswe ku barwayi bageze mu zabukuru birashobora gusobanura bimwe mu bitandukanyirizo byagaragaye uko imyaka igenda ishira, ariko amabwiriza agezweho arasaba HF kugabanya igice cyo gusohora no kubika EF.Kunanirwa k'umutima ukoresha imbibi imwe ya NT-ProBNP.58 Icya gatandatu, nubwo ubushakashatsi bwinshi bwakomeje kwandikisha abarwayi bafite dyspnoea ikaze, ubwinshi bwumutima ukabije wumutima wari mwinshi kandi kubogama guhitamo bishobora kuba bihari.Nyamara, imikorere yubuyobozi bwasabwe na NT-proBNP guhagarikwa no kugabanya imyaka ntabwo byahindutse mubisesengura ryibyiyumvo, usibye ubushakashatsi bufite ibyago byinshi byo kubogama.Hanyuma, kunanirwa k'umutima ni syndrome de clinique, kandi kwisuzumisha ubwabyo bifite gushidikanya no guhinduka mubushakashatsi.Uku kutamenya gushidikanya kurashobora kuba kwinshi mubasaza, bishobora gusobanura igice kimwe cyagaragaye mubisubizo byo gusuzuma.
Twerekanye ko imikorere yo gusuzuma indangagaciro ya NT-proBNP yaciwe mu mabwiriza yo kunanirwa k'umutima ikabije iratandukanye mu itsinda ry’abarwayi.Twateje imbere kandi twemeza amanota ya CoDE-HF, ahuza NT-pro-BNP nkigipimo gihoraho hamwe n’imihindagurikire y’amavuriro kugira ngo tumenye ko bishoboka ko umutima udakira cyane ku barwayi ku giti cyabo ukoresheje urugero rw’ibarurishamibare.Iki gikoresho cyo gushyigikira iki cyemezo cyamaganwe neza kandi kirwanya kunanirwa k'umutima kandi byakorwaga mu matsinda yose.Ubu ubushakashatsi buteganijwe burakenewe kugirango harebwe ingaruka zo gushyira mu bikorwa iki gikoresho cyo gushyigikira ibyemezo ku mikoreshereze y’ubuzima n’ibisubizo by’abarwayi.
Gupima kunanirwa k'umutima birashobora kugorana kuko abarwayi akenshi bagaragaza ibimenyetso bidasanzwe.
Amabwiriza menshi yigihugu ndetse n’amahanga arasaba gupima N-terminal B yo mu bwoko bwa natriuretic peptide precursor (NT-proBNP) kugirango isuzume ikibazo cyo kunanirwa k'umutima.
Ikizamini cya NT-proBNP nticyakoreshejwe ku isi yose kubera ibibazo bijyanye n’imikorere yo gusuzuma mu matsinda akomeye y’abarwayi.
Icyifuzo cya NT-proBNP ntarengwa cyo kunanirwa k'umutima bikabije mu mabwiriza bifite imikorere mibi yo gusuzuma mu matsinda akomeye y'abarwayi.
Igikoresho cyemewe cyo gufata ibyemezo cyateguwe gihuza NT-pro-BNP nkigipimo gihoraho hamwe n’imihindagurikire y’amavuriro ukoresheje uburyo bwo kwerekana imibare.
Iki gikoresho cyamaganwe neza kandi cyirinda kunanirwa k'umutima kurenza uburyo ubwo aribwo bwose ukoresheje NT-proBNP imbago yonyine kandi byakorwaga buri gihe mumatsinda yose.
Ubushakashatsi bwose bwakozwe hakurikijwe Itangazo rya Helsinki kandi byemejwe mu rwego rwo kwemerera gusangira amakuru ku rwego rw’abarwayi kuri iri sesengura.
Kode ya R hamwe namakuru atazwi akoreshwa mugutezimbere no kwemeza amanota ya CoDE-HF arahari kubashakashatsi babisabwe numwanditsi wabigenewe.