Diagnostic Role of NT-proBNP in Patients with Cardiac Amyloidosis Involvement: A Meta-Analysis

Abstract Background Amyloidosis is defined as a disorder characterized by the deposition of extracellular protein material of amyloid in tissues. Objectives N-terminal pro-B-type natriuretic peptide (NT-proBNP) is used to predict the cardiac amyloidosis (CA), but its diagnostic effect on CA involvement remains unclear, especially in terms of specificity and sensitivity. Methods A search for literature was conducted in the Pubmed, Embase, and Cochrane library databases, and QUADAS 2 was used for quality assessment. Midas command in Stata 12.0 was used to analyze the subject indicators. Cochran’s Q and I2were to test for heterogeneity, and the significant heterogeneity was set at p < 0.05 and/or I2> 50%. Spearman correlation analysis was used to evaluate the threshold effect, and the publication bias was assessed using the asymmetry test. The statistical significance was set at p < 0.05. Results As results, 10 sets of data from 7 studies were included for analysis, showing high methodological quality and minimal confounding bias. The sensitivity and specificity of NT-proBNP in the diagnosis of cardiac involvement for patients with amyloidosis were 0.93 and 0.84, respectively. ROC curves also suggested a high diagnostic validity of NT-proBNP with an AUC of 0.95. A Fagan’s nomogram plot showed probabilities for NT-proBNP positive and negative in developing CA involvement were 90% and 8%, respectively. The Deek’s funnel plot suggested no significant publication bias across included studies, and the results were stable and reliable. Conclusions NT-proBNP plays the positive role in the early diagnosis of CA involvement with high sensitivity and specificity.

研究背景：淀粉样变性病（Amyloidosis）是一类以组织中细胞外淀粉样蛋白物质沉积为特征的疾病。研究目的：N末端B型利钠肽原（N-terminal pro-B-type natriuretic peptide, NT-proBNP）常被用于预测心脏淀粉样变性病（cardiac amyloidosis, CA），但其对心脏受累的诊断效能尚不明确，尤其在特异性与敏感性层面。研究方法：本研究在PubMed、Embase及Cochrane图书馆数据库中开展文献检索，采用QUADAS-2量表进行质量评价。使用Stata 12.0软件中的Midas命令分析相关诊断指标。采用Cochran Q检验与I²统计量检验异质性，以P<0.05且/或I²>50%作为存在显著异质性的判定标准。采用Spearman相关分析评估阈值效应，并通过不对称检验评价发表偏倚。本研究设定P<0.05为差异具有统计学意义。研究结果：最终纳入7项研究的10组数据进行分析，纳入研究的方法学质量较高，混杂偏倚较低。NT-proBNP诊断淀粉样变性病患者心脏受累的敏感性与特异性分别为0.93与0.84。受试者工作特征（Receiver Operating Characteristic, ROC）曲线分析显示，NT-proBNP具有较高的诊断效能，曲线下面积（Area Under the Curve, AUC）为0.95。Fagan列线图结果显示，NT-proBNP检测阳性及阴性时，患者发生心脏受累的概率分别为90%与8%。Deek漏斗图分析显示，纳入研究无显著发表偏倚，研究结果稳定可靠。研究结论：NT-proBNP在心脏受累的早期诊断中具有积极价值，且具备较高的敏感性与特异性。