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Maƙasudi Don kimanta aikin bincike na N-terminal B-type natriuretic peptide precursor (NT-proBNP) kofa a cikin m zuciya gazawar, da kuma ci gaba da kuma tabbatar da wani yanke shawara goyon bayan kayan aiki da hadawa NT-proBNP taro tare da asibiti alamomi.
An gudanar da bincike na 14 daga kasashe 13, ciki har da gwaje-gwajen da ba a iya sarrafa su ba da kuma nazarin abubuwan da za a iya gani.
Bayanan matakin mahalarta ɗaya daga 10 zuwa 369 marasa lafiya tare da waɗanda ake zargi da gazawar zuciya an haɗa su don ƙididdigewa don ƙididdige yankewar NT-proBNP.Kayan aiki na goyan bayan yanke shawara (Ganewar Rashin Ciwon Zuciya da Haɗin Haɗin Haɗin Bincike (CoDE-HF)), wanda ya haɗu da NT-proBNP tare da masu canji na asibiti don bayar da rahoton yiwuwar rashin ciwon zuciya mai tsanani a cikin marasa lafiya ɗaya, an haɓaka kuma an inganta su.
SakamakoGabaɗaya, 43.9% (4549 / 10 ~ 369) na marasa lafiya sun kamu da rashin ƙarfi na zuciya (73.3% (2286/3119) da 29.0% (1802/6208) na marasa lafiya da kuma ba tare da gazawar zuciya ba).Ƙofar yanke shawarar gudanarwa na 300 pg/mL yana da ƙima mara kyau na 94.6% (95% tazarar amincewa, 91.9% zuwa 96.4%); duk da amfani da ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙima ya bambanta a 61.0% (55.3% zuwa 66.4%), 73.5% (62.3% zuwa 82.3%), da 80.2% (70.9% zuwa 87.1%), a cikin marasa lafiya da suka tsufa. <50 shekaru, 50-75, da> 75 shekaru, bi da bi. duk da amfani da ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙima ya bambanta a 61.0% (55.3% zuwa 66.4%), 73.5% (62.3% zuwa 82.3%), da 80.2% (70.9% zuwa 87.1%), a cikin marasa lafiya. shekaru <50, shekaru 50-75, da> 75 shekaru, bi da bi. 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%) и 80,2% (от 70,9% до 87,1%) у пациентов в возрасте <50 лет, 50-75 лет и >75 лет соответственно. Duk da amfani da matakan shekaru a cikin dokoki, ƙimar tsinkaya mai kyau ta bambanta a cikin 61.0% (daga 55.3% zuwa 66.4%), 73.5% (daga 62.3% zuwa 82.3%) da 80.2% (daga 70.9% zuwa 87.1%) a cikin marasa lafiya. shekaru <50, shekaru 50-75 da> 75 shekaru, bi da bi.Duk da yin amfani da shekaru kofa a cikin mulkin, a tsakanin tsofaffi marasa lafiya, kyawawan dabi'un tsinkaya sun kasance 61.0% (kewayon 55.3% zuwa 66.4%), 73.5% (kewayon 62.3% zuwa 82.3%) da 80. 2% (daga 70.9). % zuwa 87.1%).) canzawa tsakanin. <50 岁, 50-75 岁和>75 岁. <50岁, 50-75岁和>75岁. <50 лет, 50-75 лет и >75 lет. <50 shekaru, 50-75 shekaru da>75 shekaru.Bayyanar cututtuka sun bambanta a yawancin ƙananan ƙungiyoyi, musamman a cikin ƙungiyoyi masu kiba, rashin wadatar koda, ko tarihin gazawar zuciya.CoDE-HF an daidaita shi da kyau kuma yana da kyakkyawar wariya tsakanin marasa lafiya tare da kuma ba tare da tarihin gazawar zuciya ba (yanki a ƙarƙashin tsarin mai karɓar mai aiki 0.846 (0.830 zuwa 0.862) da 0.925 (0.919 zuwa 0.932), bi da bi, da Brier maki na 0.130 da 0.099, bi da bi).).A cikin marasa lafiya ba tare da gazawar zuciya ta farko ba, ganewar asali ya kasance daidai a duk ƙungiyoyin ƙungiyoyi tare da ƙarancin yuwuwar 40.3% (2502/6208) (ƙimar tsinkayar mara kyau 98.6%, 97.8% zuwa 99.1%) da 28.0% (1737/6208) yuwuwar yiwuwar. m ciwon zuciya ya yi girma (tabbatacciyar ƙimar 75.0%, 65.7% zuwa 82.5%).
Kammalawa A cikin kimantawar haɗin gwiwar kasa da kasa game da aikin bincike na NT-proBNP, ƙofofin da aka ba da shawarar a cikin jagororin don gano cututtukan zuciya mai tsanani sun bambanta sosai tsakanin mahimman ƙungiyoyin marasa lafiya.CoDE-HF Decision Support Tool yana haɗa NT-proBNP zuwa ci gaba da ma'auni da sauran ma'auni na asibiti, yana samar da mafi daidaituwa, daidai da keɓaɓɓen hanya.
Kusan mutane miliyan 1 a Burtaniya suna fama da ciwon zuciya kuma ana sa ran yaduwar zai karu da kusan 50% a cikin shekaru 25 masu zuwa saboda yawan tsufa.1 Rashin raunin zuciya mai tsanani yana da kashi 5% na duk asibitocin da ba a shirya su ba.2 Madaidaicin ganewar asali kuma akan lokaci na rashin ciwon zuciya mai tsanani na iya zama ƙalubale, kuma duka jagororin ƙasa da na ƙasa suna ba da shawarar gwaji don peptides na natriuretic don taimakawa wajen gano cutar.345678 Duk da waɗannan shawarwari, gwajin gwajin N-terminal B-type natriuretic peptide precursor (NT-proBNP) ba a yi shi akai-akai ba, a wani ɓangare saboda damuwa game da amfanin asibiti a cikin ainihin duniya.Nazarin da ke bincikar aikin bincike na NT-proBNP an gudanar da su ne a cikin ƙananan zaɓaɓɓun ƙungiyoyin marasa lafiya, waɗanda ke iyakance ikon haɓaka sakamakon zuwa ƙungiyoyi masu mahimmanci na asibiti, kamar tsofaffi marasa lafiya da marasa lafiya tare da gazawar koda ko kiba, inda waɗannan halayen suka bambanta. tabbatacce.yana ƙara zama na kowa a cikin marasa lafiya da ciwon zuciya.91011 Hanyoyin ƙididdiga na ƙididdiga waɗanda ke yin la'akari da halaye masu haƙuri don samar da ƙarin ƙididdiga na keɓaɓɓu na iya samun daidaiton aikin bincike a cikin sassan marasa lafiya.12
Ko da yake an ƙirƙiri samfura da yawa don yin hasashen hasashen a cikin marasa lafiya tare da gazawar zuciya, ƙananan ƙirar zasu iya taimakawa wajen gano cututtukan zuciya mai tsanani.13141516171819 Ƙoƙarin da suka gabata sun sami fa'idodi da yawa amma sun haɗa da sauye-sauye na zahiri kamar yuwuwar gwajin likitocin asibiti ko kwatancin alamun haƙuri.Bugu da ƙari, sun haɗa da NT-proBNP a matsayin mai canzawa na binary kuma ba su yi la'akari da ma'amala mai ƙarfi da rashin daidaituwa tsakanin NT-proBNP da sauran masu canji na asibiti ba.Ƙoƙarin da aka yi a baya don haɓakawa da tabbatar da ma'aunin bincike sun kuma haɗa da ƙayyadaddun adadin marasa lafiya daga wuri guda, wanda ya hana kimanta tasiri a cikin ƙananan ƙungiyoyi kuma yana iyakance yiwuwar ƙaddamarwa na waje.
A cikin wannan haɗin gwiwar bincike na kasa da kasa, mun kimanta aikin bincike na jagororin' shawarwarin NT-proBNP masu ƙima don raunin zuciya mai tsanani a cikin rukunin marasa lafiya.Daga baya, mun haɓaka kuma mun tabbatar da kayan aikin tallafi na yanke shawara ga marasa lafiya waɗanda ake zargi da gazawar zuciya mai ƙarfi waɗanda suka yi amfani da ƙirar ƙididdiga don haɗa abubuwan NT-proBNP tare da halayen asibiti.
Mun gudanar da nazari na yau da kullum don gano binciken da ke kimanta aikin bincike na NT-proBNP a cikin marasa lafiya da ake zargi da ciwon zuciya mai tsanani.Mun sabunta wani bita na baya ta Roberts et al1 don haɗa kalmomin "rashin zuciya" da "natriuretic peptides" ta hanyar bincika Embase, Medline, da Babban Rijista na Cochrane na Gwaje-gwajen Sarrafa don lakabi da bayanan da aka buga akan 18 Agusta 2021 (Ƙarin Rubutu 1) .Nazarin da aka yi la'akari da cancanta idan sun hadu da wadannan predefined hada sharudda: rajista na marasa lafiya da shekaru ≥18 shekaru tare da zargin m zuciya gazawar a cikin gaggawa wuri, auna NT-proBNP a cikin jini samfurori samu a lokacin da haƙuri ta farko kima a ranar shigar, kuma An yi ganewar asali na rashin ƙarfi na zuciya ta amfani da ka'idodin tunani masu karɓuwa.Masu bincike guda biyu (KKL da MA) sun sake nazarin duk binciken da aka gano ta hanyar binciken wallafe-wallafen da aka tsara, kuma na uku (NLM) ya yanke shawarar rikici ta amfani da ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun tsarin (PROSPERO rajista: CRD42019159407).
Mun tuntuɓi mawallafa daban-daban don duk ƙungiyoyin da suka cancanta don neman bayani game da ƙididdigar NT-proBNP, an tabbatar da ganewar asali na ciwon zuciya mai tsanani, ƙididdiga (shekaru, jinsi, tsere), tarihin farko (ciwon zuciya, cututtukan jini na jijiyoyin jini, matakin mara lafiyar mutum wanda ba a san shi ba) .bayanai game da ciwon sukari), hauhawar jini, hyperlipidemia, shan taba, fuka, cututtukan huhu na yau da kullun, cututtukan koda na yau da kullun), sigogin ilimin lissafi (yawan zuciya da hawan jini) a farkon gwajin, na asibiti haematological da biochemical halaye.Mun bincika tare da duk marubutan da suka dace don daidaito, ma'anar masu canji, da cikawa kafin yarjejeniya.An gudanar da duk karatun bisa ga sanarwar Helsinki kuma an yarda da su cikin ɗabi'a don ba da damar raba bayanai a matakin majinyacin mutum don wannan ƙididdigar meta.Masu bincike guda biyu (KKL da MA) sun tantance haɗarin rashin son kai ga kowane binciken ta amfani da Kayan aikin Assessment Quality Assessment in Diagnostic Accuracy, sigar 2 (QUADAS-2), da rikice-rikice na 20 an warware su ta wani ɓangare na uku (NLM).
Mun samo ƙididdiga na meta tare da tazarar amincewa 95% na hankali, ƙayyadaddun ƙayyadaddun ƙima, ƙimar tsinkaya mara kyau, da ƙimar tsinkaya mai kyau na jagorar da aka ba da shawarar NT-proBNP ikon fitar da kofa (300 pg/mL) 450, 900, da 1800 pg / mL ga marasa lafiya masu shekaru <50, 50-75, da> 75 shekaru, bi da bi) 7 don rashin ciwon zuciya mai tsanani ta hanyar amfani da tsarin matakai guda biyu, tare da ƙididdiga da aka ƙididdige su daban a cikin kowane binciken sannan a haɗa su a cikin nazarin. a cikin samfurin bazuwar sakamako na al'ada-binomial-al'ada ta amfani da hanyar DerSimonian da Laird.21 Mun ƙara kimanta aikin waɗannan ƙofofin a cikin ƙayyadaddun ƙayyadaddun rukunonin da aka ƙayyade ta shekaru, jima'i, kabilanci, ƙididdigar jiki, aikin renal, anemia, da gaban comorbidities (na baya zuciya gazawar, hauhawar jini, hyperlipidemia, ciwon sukari mellitus, atrial fibrillation, na kullum obstructive huhu cuta). 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.对 指南 推荐 的 推荐 的 的排除 的 排除 的/ ml) 7, 采用 两 项 中 中 研究 中 二 中 中 中 中 中 了 了 中 在 在 在 在 在 了这些按, 性别, 性别, 体重 指数, 肾 功能, 贫血 功能和, 贫血肾, 和血压, 高高, 高脂血症, 糖尿病, 心心, 糖尿病, 心 房房, 慢性 阻塞 性 肺病).对 指南 的 的 ripnp 排除 的阈值 (300 пг / М 的 <50,50-75 和 1800 стр. / Мл 和 1800 стр. / М 和) 7, 采用 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 ... .... 效应The 按 按, 肾 功能, 和 功能 合并症 (既往 心力心力, 高 血压 高脂血症, 糖尿病 心 房房 慢性 阻塞 性 肺病) ....使用 方法, 我们我们 评估 了 Nt-MPpnP 浓度 浓度 浓度 浓度 浓度 的 的 诊断性能 的 的 的排除 的 的 ≥患者患者 具 具 的 的 ≥具 ≥ ≥患者患者 的 ≥患者患者 ≥具 具具 的 ≥患者患者 ≥ ≥患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者患者 具具 具 的 的 ≥具具阈值
Mun ƙididdige ƙima (0-100) daidai da yuwuwar haɓaka mummunan raunin zuciya a cikin majiyyaci ɗaya ta amfani da ƙirar ƙididdiga.Saboda bambance-bambance masu mahimmanci a cikin yaduwar cututtuka da rashin ƙarfi na zuciya, mun ƙirƙira da ingantattun samfura don marasa lafiya da kuma ba tare da gazawar zuciya ba, bi da bi.Mun yi amfani da ƙididdiga na NT-proBNP a matsayin ma'auni mai ci gaba da zaɓaɓɓen ma'auni masu sauƙi na asibiti da aka sani da suna da alaƙa da rashin ciwon zuciya mai tsanani wanda ke da mahimmancin dangi a lokacin horo na samfurin mu (shekaru, ƙididdigar tacewa na glomerular, haemoglobin, jikunan index na taro. )., bugun zuciya, hawan jini, edema na gefe, cututtukan huhu na huhu da cututtukan zuciya na ischemic) (Ƙarin rubutu 2).
A cikin haɓaka Code-HF, mun kimanta nau'ikan ƙididdiga daban-daban guda huɗu: Samfuran Haɗe-haɗe na Linear, Naive Bayes, Random Forest, da Extreme Gradient Boost (XGBoost) (Ƙarin Rubutu 2).222324 Don yin lissafin bacewar bayanai a cikin binciken (Ƙarin Hoto A), mun ninka bayanan da aka ƙidaya 10 ta amfani da ƙirar ƙira mai yawa tare tare da keɓaɓɓen matrix na ƙayyadaddun ƙayyadaddun haɗin kai wanda ya dace da tsarin sarkar Monte Carlo Markov.25 Mun yi ƙima da yawa don duk masu canji da aka haɗa a cikin ƙirar ban da NT-proBNP.Mun yi maimaitawa 10 na tabbatar da giciye-ninki 10 don kowane samfuri kuma mun yi amfani da ƙididdigar tsaka-tsakin ƙima da ƙididdiga na bayanai azaman ƙididdigar CoDE-HF ga kowane mai haƙuri.Daga baya, mun gano maki waɗanda suka rarraba mafi yawan adadin marasa lafiya tare da babban ko ƙananan yuwuwar rashin ƙarfi na zuciya, tare da mafi kyawun aiki don ware (75% ƙimar tsinkaya mai kyau da 90% ƙayyadaddun) kuma don ware (98% ƙimar tsinkaya mara kyau da 90). % ƙayyadaddun ƙayyadaddun bayanai) % hankali) a cikin matsanancin raunin zuciya.
Mun kimanta aikin kowane samfuri akan kewayon ma'aunin bincike (yankin da ke ƙarƙashin madaidaicin aiki mai karɓa, ƙimar Brier, rabon marasa lafiya da ke samun babban ma'aunin yuwuwar ƙarancin yuwuwar, da ƙimar tsinkaya mai kyau da mara kyau ga ƙungiyoyin marasa lafiya).Maki na Brier nuna wariya ne da ma'aunin daidaitawa da aka ƙididdige su ta hanyar ɗaukar daidaitaccen kuskure tsakanin yuwuwar hasashen da abubuwan lura.26 Mun zaɓi samfurin mafi inganci don kayan aikin goyan bayan yanke shawara na Code-HF.Muna kimanta aikin CoDE-HF ta amfani da bincike mai lanƙwasa yanke shawara da tabbatarwar ciki da waje.A taƙaice, wannan hanyar tana yin watsi da nazari ɗaya lokaci guda don ingantaccen waje kuma yana amfani da ragowar karatun don haɓaka ƙirar.27 Ba mu shigar da ƙima a cikin bayanan ingantattun bayanan waje ba don haka ba mu inganta na waje ba don yawancin karatun.Mai canjin ya kasance gaba ɗaya babu (Ƙarin Hoto A).Mun yi amfani da sigar R 4.1.2 don duk nazari.
Marasa lafiya da membobin hukumar jama'a sun halarci fassarar sakamakon.Akwai shirye-shiryen watsa sakamakon ga al'ummar marasa lafiya da suka dace.
Mun tuntubi masu bincike daga binciken da suka cancanta 30, wanda 19 suka amsa.Nazarin goma sha huɗu (12 masu yiwuwa na nazarin ƙungiyoyi da gwaje-gwajen gwaji guda biyu) sun ba da bayanan matakin marasa lafiya daga 10 zuwa 369 marasa lafiya da ake zargi da ciwon zuciya mai tsanani (ma'anar shekaru 69.3 shekaru; 53.3% maza) daga kasashe 13 (Table 1).Hoto B;Ƙarin Tables A da B) 1528293031323334353637383940 An gudanar da duk nazarin a cikin sashen gaggawa, ban da binciken daya wanda ya haɗa da marasa lafiya na zuciya da na huhu (yana nufin 488 marasa lafiya a kowace nazarin (quartile. Bit spacing 322-1053)).Gabaɗaya, 43.9% (4549 / 10,369) na marasa lafiya sun tabbatar da ganewar asali na rashin ƙarfi na zuciya (yawan nazarin matsakaicin 46% (31-54%).A cikin marasa lafiya tare da ciwon zuciya na farko, abin da ya faru na ciwon zuciya mai tsanani ya kasance mafi girma fiye da marasa lafiya ba tare da ciwon zuciya ba (73.3% (2286/3119) vs. 29.0% (1802/6208)) (Ƙarin Table C).
Halayen tushe na marasa lafiya waɗanda aka keɓe ta hanyar ganewar rashin ƙarfi na zuciya.Dabi'u sune lambobi (kashi) sai dai in an lura da su
A shawarar da aka ba da shawarar keɓance kofa na 300 pg/mL, haɗe-haɗe-haɗin ƙima na ƙimar ƙima mara kyau, azanci, ƙimar tsinkaya mai kyau, da ƙayyadaddun NT-proBNP a cikin yawan jama'a shine 94.6% (95% tazarar amincewa, 91.9%) .zuwa 96.4%), 96.8% (daga 94.6% zuwa 98.1%), 62.9% (daga 51.3% zuwa 73.3%) da 49.3% (daga 35.4% zuwa 63.4%) (Hoto na 1; Karin Teburin D).Gabaɗaya, 30.4% (3148/10,369) na marasa lafiya suna da matakan NT-proBNP da ke ƙasa 300 pg/mL.Duk da haka, akwai alamar rashin daidaituwa tsakanin ƙungiyoyin marasa lafiya da karatu (Hoto 2; Hoto 3; Ƙarin Figures C da D).Ƙimar tsinkaya mara kyau sun kasance ƙasa a cikin marasa lafiya ≥75 shekaru (88.2%, daga 83.5% zuwa 91.8%), da kuma a cikin marasa lafiya da tarihin ciwon zuciya (79.4%, daga 68.4% zuwa 87.3%) da kiba. (90.4%, daga 84.5% zuwa 87.3%).94.2%.
N-terminal bakin kofa na pro-B-nau'in natriuretic peptide (NT-proBNP) a cikin m zuciya gazawar.Hagu na sama: Ƙimar ƙimantawa mara kyau na NT-proBNP maida hankali don ware ganewar asali na m ciwon zuciya.Ƙasa na hagu: Tarin adadin marasa lafiya da ake zargin m zuciya gazawar tare da NT-proBNP taro a kasa kowane kofa.Babban dama: Ƙimar tsinkayar ƙima na NT-proBNP maida hankali don gano cututtukan zuciya mai tsanani.Ƙasan dama: Tarin adadin marasa lafiya da ake zargi da gazawar zuciya mai tsanani tare da NT-proBNP sama da kowane kofa.
Ayyukan bincike na jagororin-shawarar matakan N-tasha don nau'in peptide natriuretic na nau'in B-pro-B a cikin ƙananan ƙungiyoyin haƙuri: ƙimar ƙima mara kyau na 300 pg/mL.COPD = cututtukan huhu na yau da kullun;eGFR = kimanta yawan tacewa na glomerular
Ayyukan bincike na jagororin sun ba da shawarar NT-proBNP kofa a cikin ƙungiyoyin ƙungiyoyin haƙuri: ƙimar tsinkayar ƙima na ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙungiyoyin haƙuri (450, 900, da 1800 pg/mL don <50, 50-75, da> 75 shekaru, bi da bi). Ayyukan bincike na jagororin sun ba da shawarar NT-proBNP kofa a cikin ƙungiyoyin ƙungiyoyin haƙuri: ƙimar tsinkayar ƙima na ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙungiyoyin haƙuri (450, 900, da 1800 pg/mL don <50, 50-75, da> 75 shekaru, bi da bi). 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). Ayyukan bincike na ƙofofin NT-proBNP da aka ba da shawarar don ƙungiyoyin ƙungiyoyin haƙuri: ƙimar tsinkayar ƙima na ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙungiyoyin haƙuri (450, 900, da 1800 pg/mL don <50, 50-75, da> 75 shekaru, bi da bi) .的 的 跨患者 跨患者 跨患者 跨患者 的 的 的 性能 的 年龄 诊断 的 的 年龄 为 为 的 年龄 为 的 阳性阳性 (7,50-75 和> 75 !).的 的 跨患者 的 的 的 的 的 的 性能: 性能 性能 的 的 年龄 的 的 年龄 年龄 的阳性 阳性 (分别 为 为 500,50 和 1800 PG / ML, <50,50-75 和> 75 岁). 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) . Ayyukan bincike na jagororin-shawarar madaidaicin NT-proBNP don ƙungiyoyin masu haƙuri: ƙimar tsinkayar ƙima na ƙayyadaddun ƙayyadaddun ƙima don ƙungiyoyin marasa lafiya (450, 900, da 1800 pg/mL, <50, 50-75, da> 75, bi da bi na shekaru) ) .COPD = cututtukan huhu na yau da kullun;eGFR = kimanta yawan tacewa na glomerular
Ƙididdigar ƙididdiga masu ƙima na ƙimar tsinkaya mai kyau na shekaru yanke-offs na NT-proBNP 450, 900, da 1800 pg/mL mulki sun kasance 61.0% (55.3% zuwa 66.4%), 73.5% (62.3% to 82). 3%) da 80.2%, bi da bi (70.9% zuwa 87.1%) (Table 2).Abubuwan da suka dace daidai da kashi 87.8% (79.5% zuwa 93.0%), 81.1% (72.6% zuwa 87.5%), da 73.1% (65.2% zuwa 79. takwas%).Gabaɗaya, 48.7% (5052/10,369) na marasa lafiya da ake zargi da gazawar zuciya mai tsanani suna da NT-proBNP sama da waɗannan shekarun.Duk da bambancin ra'ayi a tsakanin ƙungiyoyin shekaru, aikin koda, da kuma yawan rashin ciwon zuciya mai tsanani, a cikin ƙungiyoyin ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙa'idodin, shekarun da aka yanke na dokokin suna da ƙididdiga masu kyau fiye da yanke guda ɗaya na 300 pg/mL (Ƙarin Hoto EI) .
Ayyukan bincike na nau'in nau'in N-terminal B natriuretic peptide precursor (NT-proBNP) shekarun kofa don gazawar zuciya.
Gabaɗaya, mun gano bincike guda bakwai a babban haɗarin son zuciya (Ƙarin Teburin A).A cikin nazarin hankali da aka iyakance ga binciken da aka makantar da shi zuwa abubuwan NT-proBNP don yanke hukunci game da raunin zuciya mai tsanani da karatu tare da ƙarancin ƙarancin son zuciya, ƙa'idodin ƙa'idodin da aka ba da shawarar samfuran bincike da yankewar shekaru don NT-proBNP sun kasance ba su canzawa (Ƙarin Tables E da F )..
Matsakaicin 100 pg/mL NT-proBNP ya hadu da mafi kyawun ƙa'idodin keɓancewar mu tare da ƙimar ƙimar tsinkaya mara kyau na 97.8% (kewayon 95.8% zuwa 98.8%) da azanci na 99.3% (kewayon 98.5% zuwa 99.7%) (Ƙarin Teburin D) .Duk da haka, kawai 17.9% (1851 / 10 ~ 369) na marasa lafiya suna da nauyin NT-proBNP da ke ƙasa da 100 pg / mL, kuma sun kasance marasa kyau a cikin tsofaffi marasa lafiya da marasa lafiya da ciwon zuciya, cututtukan zuciya, da kuma tarihin rashin lafiya Hasashen sun kasance matalauta. ..Ayyukan koda (Ƙarin Hoto J).Hakazalika, yankewar 1000 pg/mL NT-proBNP ya cika mafi kyawun ma'aunin kimanta mu tare da ƙimar tsinkayar 74.9% (64.4% zuwa 83.2%) da ƙayyadaddun 76.1% (65.6% zuwa 84.2%).ya kasa.Bambanci.Hakanan ya kasance ƙasa a cikin ƙungiyoyin marasa lafiya, musamman waɗanda ba su da tarihin gazawar zuciya na baya (ƙimar tsinkaya mai kyau 62%, 41% zuwa 79%) (Ƙarin Teburin D; Ƙarin Hoto K).
Matsakaicin haɓakar haɓakar gradient (XGBoost) da samfurin gauraye na layin layi sune mafi kyawun ƙirar aiki (yankin da ke ƙarƙashin lanƙwasa a cikin jimlar ƙungiyar horo 0.925 (95% CI 0.919 zuwa 0.932) da 0.931 (0.925 zuwa 0.937), bi da bi) (Kari) Rubutu 2).Ko da yake aikin XGBoost yayi kama da haɗaɗɗun nau'ikan haɗaɗɗun linzamin kwamfuta, babban fa'idar XGBoost shine ikonsa na ƙididdige ƙididdigewa lokacin da aka rasa ƙima.Wannan muhimmin fasali ne da muke fatan aiwatarwa a cikin kayan aikin goyan bayan yanke shawara na CoDE-HF don sauƙaƙe aiwatarwa a cikin aikin asibiti, wanda shine dalilin da ya sa muka zaɓi samfurin XGBoost a matsayin samfurin ƙarshe na CoDE-HF.
CoDE-HF an daidaita shi da kyau kuma yana da kyakkyawar wariya a cikin marasa lafiya da kuma ba tare da gazawar zuciya ba (yankin da ke ƙarƙashin tsarin mai karɓar mai aiki 0.846 (0.830 zuwa 0.862) da 0.925 (0.919 zuwa 0.932) da ƙimar Brier na 0.130 da 0.130, bi da bi).0.099) (Hoto 4; Ƙarin Hoto L).Makin Code-HF na 4.7 yana ba da ƙimar tsinkaya mara kyau na 98.6% (97.8% zuwa 99.1%) da azanci na 98.1% (96.9% zuwa 98.9%) (Ƙarin Teburin G), kuma maki na 51.2 yana ba da tsinkaya mai kyau. daraja.darajar 75.0% (65.7%) 82.5%), ƙayyadaddun shine 92.2% (87.5% zuwa 95.2%) na marasa lafiya ba tare da tarihin ciwon zuciya ba.Waɗannan ƙimar haɗawa da keɓancewa suna da aikin bincike iri ɗaya a cikin duk rukunin ƙungiyoyi (Hoto na 5, Hoto 6, Hoto 7). Idan an yi amfani da waɗannan ƙididdiga a cikin marasa lafiya da ake zargi da gazawar zuciya mai tsanani, CoDE-HF zai gano 40.3% (2502/6208) a ƙananan yuwuwar (<4.7) da 28.0% (1737/6208) a babban yuwuwar (≥51.2) na m zuciya gazawar. Idan an yi amfani da waɗannan ƙididdiga a cikin marasa lafiya da ake zargi da gazawar zuciya mai tsanani, CoDE-HF zai gano 40.3% (2502/6208) a ƙananan yuwuwar (<4.7) da 28.0% (1737/6208) a babban yuwuwar (≥51.2) na m zuciya gazawar. 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) sердечной недостаточности. Idan an yi amfani da waɗannan ƙimar ga marasa lafiya da ake zargi da rashin ƙarfi na zuciya, CoDE-HF zai gano 40.3% (2502/6208) tare da ƙananan yuwuwar (<4.7) da 28.0% (1737/6208) tare da babban yuwuwar (≥51.2) zuciya. gazawa.m zuciya gazawar.如果将 于 评分 应用 于 于 于 疑似 心力 心力 心力 心力 心力 心力 心力 心力 心力 的, Code-HF 将 识别 出 40.3% (2502/620) 和急性 (<4.7/620) 急性 的衰竭.将 这些 评分 评分 评分 评分 急性 急性 心力 心力 急性 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 心力 急性 心力 心力 心力 心力 心力心力 识别识别 40 40.3% (2502/620) 的 高概率高概率 (1737/6208 的高概率 的) 急性 心力 心力 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. Idan an yi amfani da waɗannan ƙididdiga ga marasa lafiya da ake zargi da rashin ƙarfi na zuciya, CoDE-HF zai bayyana 40.3% (2502/6208) ƙananan yuwuwar (<4.7) da 28.0% (1737/6208) babban yuwuwar (≥ 51.2) m ciwon zuciya.gajiya.A cikin majiyyatan da ke da raunin zuciya da suka kasance a baya, babu ɗaya daga cikin maki a cikin ƙungiyar horon da ya cika ka'idodin keɓance manufar mu.Makin Code-HF shine 84.5, ingantaccen ƙimar tsinkaya shine 92.7% (89.1% zuwa 95.2%), kuma takamaiman shine 90.2% (84.0% zuwa 94.1%).Wannan kima zai gano 45.5% (1420 / 3119) na marasa lafiya tare da babban yiwuwar bunkasa ciwon zuciya mai tsanani (Fig. 8).A cikin binciken lanƙwan yanke shawara a duk yuwuwar kofa, CoDE-HF yana da riba mafi girma fiye da NT-proBNP kaɗai (Ƙarin Hoto M).An rage makin CoDE-HF kaɗan ba tare da tarihin horo ba (yankin da ke ƙarƙashin tsarin aikin mai karɓa shine 0.922 (0.916 zuwa 0.929) da 0.841 (0.825 zuwa 0.825 a cikin marasa lafiya ba tare da gazawar zuciya da gazawar zuciya ba) 0.857)).Tabbatar da giciye na ciki da na waje yayi kyau sosai a cikin ƙungiyar samfuran duka biyu (Ƙarin Hoto N).
Binciken Haɗin Haɗin Zuciya da Sikelin Ƙimar (CoDE-HF) an daidaita shi zuwa daidaitaccen adadin marasa lafiya da ke da raunin zuciya mai tsanani.Layin dige-dige yana nuna madaidaicin daidaitawa.Kowane batu yayi daidai da marasa lafiya 100.Sama: Ƙimar CoDE-HF a cikin majiyyaci ba tare da gazawar zuciya ba.Ƙasa: Ƙimar CoDE-HF a cikin majiyyaci tare da tarihin gazawar zuciya.
Ayyukan bincike na Ƙunƙarar Zuciya Haɗin Haɗin Bincike da Sikelin Aiki (CoDE-HF) a cikin ƙungiyoyin marasa lafiya.Makin cirewa na CoDE-HF yana da ƙima mara kyau na 4.7 a cikin rukunin marasa lafiya ba tare da tarihin gazawar zuciya ba.CoDE-HF yana amfani da N-terminal natriuretic peptide type B precursor maida hankali a matsayin ci gaba da ma'auni da predefined sauki haƙiƙa masu canji na asibiti (shekaru, kiyasin glomerular tacewa (eGFR), haemoglobin, jiki taro index, zuciya rate, hawan jini, gefe edema, na kullum obstructive. cututtukan huhu (COPD) da cututtukan zuciya na zuciya) suna ba da ƙima na mutum ɗaya game da yuwuwar gano cutar rashin ƙarfi na zuciya.
Ayyukan bincike na ma'auni na CoDE-HF akan Haɗin kai don Bincike da Ƙwararren Ƙwararrun Zuciya a cikin ƙungiyoyin marasa lafiya.Makin ƙa'idar Code-HF yana da ƙimar tsinkaya mai kyau na 51.2 a cikin rukunin marasa lafiya ba tare da tarihin gazawar zuciya ba.CoDE-HF ya haɗu da ƙididdigar NT-proBNP azaman ci gaba da ma'auni da ƙayyadaddun ma'auni masu sauƙi na asibiti (shekaru, ƙimar tacewar glomerular (eGFR), haemoglobin, ma'aunin jiki, ƙimar zuciya, hawan jini, edema na gefe, cututtukan huhu na huhu (COPD) ).cututtuka na jijiyoyin jini) suna ba da kima na mutum ɗaya game da yuwuwar gano cutar rashin ƙarfi na zuciya
Ayyukan bincike na Haɗin kai don Ganewa da Ƙimar Ƙunar Zuciya (CoDE-HF) a cikin ƙananan ƙungiyoyin haƙuri.Makin ƙa'idar Code-HF yana da ƙimar tsinkaya mai kyau na 84.5 a cikin marasa lafiya tare da tarihin raunin zuciya a cikin rukunin marasa lafiya.CoDE-HF ya haɗu da ƙididdigar NT-proBNP azaman ci gaba da ma'auni da ƙayyadaddun ma'auni masu sauƙi na asibiti (shekaru, ƙimar tacewar glomerular (eGFR), haemoglobin, ma'aunin jiki, ƙimar zuciya, hawan jini, edema na gefe, cututtukan huhu na huhu (COPD) ).cututtuka na jijiyoyin jini) suna ba da kima na mutum ɗaya game da yuwuwar gano cutar rashin ƙarfi na zuciya
Binciken Haɗin Haɗin Zuciya da Sikelin Assessment (CoDE-HF) ba shi da tasiri a cikin marasa lafiya tare da tarihin gazawar zuciya.Sama: Mara kyau da ƙimar tsinkaya masu inganci don maki CoDE-HF.Layin shuɗi mai digo a tsaye yana nuna maƙasudin kawar da maki na 4.7.Layin jajayen dige-dige na tsaye yana nuna ƙimar ƙa'idar manufa ta 51.2.A ƙasa: taswirar ƙimar ƙimar CoDE-HF a cikin marasa lafiya ba tare da tarihin gazawar zuciya ba.Maƙasudin keɓancewa da ƙa'ida sun gano 40.3% na marasa lafiya da ƙarancin yuwuwar da 28.0% tare da babban yuwuwar, bi da bi.
Marasa lafiya da aka gano a matsayin ƙananan yuwuwar ta hanyar CoDE-HF sun sami raguwar duk sanadi da mutuwar CV a cikin kwanakin 30 da shekara 1 fiye da marasa lafiya da aka gano a matsayin tsaka-tsaki da yuwuwar (30-rana duk-mutuwar mace-mace: 1. 0% idan aka kwatanta da 4.0). % da 10.4%).mace-mace daga duk abubuwan da ke faruwa a cikin shekara guda: 5.9% zuwa 17.8% da 33.4%, bi da bi;Mutuwar kwanaki 30 daga cututtukan zuciya: 0.2% vs. 0.8% da 4.1%;mace-mace na shekara-shekara daga cututtukan zuciya: 1.4% da 3.4% da 16.3%, bi da bi) (Fig. 9). A cikin marasa lafiya tare da ƙididdigar NT-proBNP <300 pg/mL idan aka kwatanta da waɗanda ≥300 pg/mL, duk abubuwan da ke haifar da mace-mace sun kasance 0.8% da 7.6% a cikin kwanaki 30 da 5.9% a kan 26.6% a shekara guda, bi da bi, kuma Yawan mace-mace na zuciya da jijiyoyin jini ya kasance 0.1% da 2.6% a cikin kwanaki 30 da 1.3% da 10.2% a shekara guda, bi da bi (karin tebur H; ƙarin adadi O). A cikin marasa lafiya tare da ƙididdigar NT-proBNP <300 pg/mL idan aka kwatanta da waɗanda ≥300 pg/mL, duk abubuwan da ke haifar da mace-mace sun kasance 0.8% da 7.6% a cikin kwanaki 30 da 5.9% a kan 26.6% a shekara guda, bi da bi, kuma Yawan mace-mace na zuciya da jijiyoyin jini ya kasance 0.1% da 2.6% a cikin kwanaki 30 da 1.3% da 10.2% a shekara guda, bi da bi (karin tebur H; ƙarin adadi O). У пациентов с концентрацией NT-proBNP <300 пг/мл по сравнению с таковой ниже 300 пг/мл смертность от всех причин составила 0,8% по сравнению с 7,6% через 30 дней и 5,9% по сравнению с 26, 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). A cikin marasa lafiya tare da ƙaddamarwar NT-proBNP <300 pg / ml idan aka kwatanta da wanda ke ƙasa da 300 pg/ml, duk-mutuwar mace-mace ita ce 0.8% idan aka kwatanta da 7.6% a kwanakin 30 da 5.9% idan aka kwatanta da 26, 6% a shekara guda, bi da bi. , kuma adadin mutuwar CV ya kasance 0.1% da 2.6% a cikin kwanaki 30 da 1.3% da 10.2% a shekara guda, bi da bi (Ƙarin Teburin H; Ƙarin Hoto O). Nt-clpnp 浓度 <300 pg / ml 的 的患者300 pg / ml 的 的患者3 pg / ml 的 的患者相比 pg / ml 的 的和, 30 的年 的 7.6% 和 7.6% 和 26.6% 和 26.6%, 以及 心血管死亡率在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；补光得。 Nt-fannoni 浓度 <300 pg / ml 的3与00 pg / ml 的与 p 相比 ,,, 的 的 7.6% 为 7.6% 为 7.6% 和 7.6% 和 7.6% 和 7.6%, 心血管 心血管 以及 在 为 为 为 为 为 为 为 为 为 为 为 为 为 为 0 天时 分别 0.1% 和 2.6%, 一3% 和 10.2% (补充 表 H; 补充 图 o ） Пациенты с концентрацией NT-proBNP <300 пг/мл по сравнению с ≥300 пг/мл имели 30-дневную смертность от всех причин 0,8% и 7,6% соответственно, 5,9% и 26,6% в течение одного года, а также сердечно-сосудистую смертность. Marasa lafiya tare da ƙididdigar NT-proBNP <300 pg/mL idan aka kwatanta da ≥300 pg/mL suna da 30-day-duk-sakamakon mace-mace na 0.8% da 7.6%, bi da bi, 5.9% da 26.6% a cikin shekara guda, da kuma mutuwar zuciya da jijiyoyin jini.sun kasance 0.1% da 2.6% a kwanaki 30 da 1.3% da 10.2% a shekara 1 (Ƙarin Teburin H; Ƙarin Hoto O).
Tarin adadin mace-mace duka-duka wanda Haɗin gwiwa don Bincike da Ƙimar Rashin Zuciya (CoDE-HF) ƙungiyar yuwuwar.
Mun yi wani meta-bincike na mutum-matakin matakin haƙuri don kimanta aikin bincike na NT-proBNP kofa a cikin fiye da marasa lafiya 10 da ake zargi da m ciwon zuciya da aka haɗa a cikin 14 masu yiwuwa karatu daga 13 kasashe da muka tsara da kuma aiwatar ta amfani da NT-proBNP.proBNP azaman kayan aikin tallafi na yanke shawara don ci gaba da aunawa.Mun bayar da rahoton sakamako masu mahimmanci da yawa.Na farko, ƙofofin da aka ba da shawarar jagororin don ban da rashin gazawar zuciya ba iri ɗaya ba ne a cikin mahimman ƙungiyoyin marasa lafiya.3 Kodayake yawan jama'a da ƙungiyoyi da yawa, gami da ƙananan marasa lafiya da mata, sun yi kyau sosai, tsofaffin marasa lafiya da mata suna da ƙarancin ƙima mara kyau.A cikin marasa lafiya tare da kiba ko gabanin gazawar zuciya, ƙarancin ƙarancin ƙarya ya tashi daga ɗaya cikin goma zuwa ɗaya cikin biyar.Abu na biyu, ƙofofin shekarun da suka dace sun nuna kansu da kyau a cikin ganewar cututtukan zuciya mai tsanani.Koyaya, ƙimar tsinkayar tabbatacce ta kasance ƙasa a cikin ƙananan marasa lafiya.Na uku, ko da yake mu inganta NT-proBNP yanke-offs na 100 pg / mL don yin sarauta daga m zuciya rashin cin nasara da 1000 pg / mL don yin hukunci a kan m zuciya rashin cin nasara da kyau kwarai da m darajar tsinkaya a cikin yawan jama'a, tsofaffi marasa lafiya sun fi muni. .a marasa lafiya da m zuciya gazawar.Ciwon zuciya na baya da kiba.A ƙarshe, mun haɓaka kuma mun inganta kayan aikin tallafi na yanke shawara, ƙimar CoDE-HF, tare da kyakkyawan aikin bincike a cikin duk ƙungiyoyin marasa lafiya.Wannan kayan aikin goyan bayan yanke shawara an cire shi kuma ya yanke hukuncin rashin gazawar zuciya daidai da kowace hanya ta amfani da madaidaicin NT-proBNP.
Don iliminmu, wannan shine mafi girman binciken har zuwa yau yana kimanta aikin bincike na NT-proBNP a cikin raunin zuciya mai tsanani.Dukkan karatun da aka haɗa sune masu yiwuwa kuma an gudanar da bincike na ƙarshe ta hanyar ƙungiyar likitocin ta yin amfani da duk bayanan da aka samu.Yana da mahimmanci a lura cewa samuwar bayanai a matakin mutum mai haƙuri a cikin yawan jama'a na binciken yana ba da damar ingantaccen ƙima game da aikin bincike na duk yuwuwar NT-proBNP a cikin ƙungiyoyin marasa lafiya, da haɓakawa da tabbatar da sabbin ma'aunin bincike.
Yawancin jagororin ƙasa da na ƙasa suna ba da shawarar yin amfani da ƙimar yankewar NT-proBNP na 300 pg/mL don yin watsi da rashin gazawar zuciya58 dangane da yawancin binciken da suka gabata344142 yana ba da rahoton ƙimar tsinkaya mara kyau na 98% a wannan yanke.Ba a iya tantance aikin bincike na ƙungiyoyi masu mahimmanci na marasa lafiya ba.Nazarin mu ya yi rajista sau uku fiye da marasa lafiya da yawa kamar yadda binciken-matakin meta-bincike na baya,3 wanda ya nuna ƙarancin ƙimar tsinkaya gabaɗaya a yankewa na 300 pg/mL tare da ƙididdigar meta-ƙimar 94.6%.Mafi mahimmanci, ƙimar tsinkayar da ba ta da kyau ta kasance ƙasa da ƙasa a cikin ƙungiyoyi masu mahimmanci kamar tsofaffi marasa lafiya da marasa lafiya tare da raunin zuciya da suka rigaya, cututtukan jijiyoyin jini, da kiba.Bugu da ƙari, kusan 70% na marasa lafiya suna da nauyin NT-proBNP a sama da 300 pg / ml yanke yanke, yana nuna iyakokin yin amfani da yanki guda ɗaya a cikin aiki.Kodayake ƙananan yanke na 100 pg/mL ya sami ƙimar ƙimar tsinkaya gabaɗaya na 98%, ya yi rashin kyau a cikin mahimman rukunin marasa lafiya.Bugu da ƙari, shekaru da ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙwayar zuciya sun nuna bambancin ra'ayi a tsakanin ƙungiyoyin marasa lafiya, musamman ma a cikin waɗanda ba su da tarihin ciwon zuciya.Wannan bambance-bambancen a cikin aikin bincike yana da damuwa musamman yayin da yawan majinyatan mu ke da shekaru kuma yana da ƙarin cututtuka.Wannan ya haifar da tambayar ko jagororin asibiti ya kamata su ci gaba da ba da shawarar yin amfani da yanke-tsaye daidai lokacin da NT-proBNP ke shafar yawancin haɗari da cututtuka.
Don inganta amfanin asibiti na NT-proBNP, mun haɓaka kuma mun tabbatar da ƙimar CoDE-HF na kayan aikin tallafi na asibiti.Wannan makin ya haɗu da NT-proBNP a matsayin ma'auni mai ci gaba tare da sauƙaƙan madaidaicin madaidaicin asibiti don samar da ƙima na mutum ɗaya na yuwuwar gano cutar cututtukan zuciya.Mun nuna cewa aikin bincike na makin CoDE-HF yana da ƙarfi a cikin ƙungiyoyin marasa lafiya.CoDE-HF ya iya yin sarauta kuma ya kawar da ganewar asali na ciwon zuciya mai tsanani a cikin mafi girma rabo na marasa lafiya fiye da ingantaccen NT-proBNP kawai.Bugu da ƙari, a cikin binciken binciken mu na yanke shawara, mun gano cewa CoDE-HF yana da fa'ida mafi girma fiye da NT-proBNP ita kaɗai, a duk iyakar yuwuwar kofa.Mun yi imanin cewa wannan ƙaddamarwa yana da hankali tun lokacin da NT-proBNP alama ce ta ci gaba da haɗari kuma ƙaddamarwarsa ya dogara da wasu abubuwan da ke da alaƙa da haƙuri kamar ma'auni na jiki, shekaru, da aikin koda.434445 Duk da yake waɗannan ma'auni sun dogara ne akan ƙayyadaddun ƙayyadaddun ƙayyadaddun ayyuka, mun gane cewa waɗannan manufofin ƙila ba za a tallafa musu a duk duniya ba kuma wuraren kiwon lafiya daban-daban na iya samun haɗarin haɗari daban-daban.Amfanin yin amfani da kayan aikin tallafi na yanke shawara kamar CoDE-HF shine cewa likitocin ko cibiyoyi na iya zaɓar ma'aunin aikin bincike don yin amfani da su don yanke shawara na gida dangane da abubuwan da suka fi dacewa da kuma kasancewar ƙwararrun bugun jini ko ƙwararrun cututtukan zuciya..
Muna sa ran sabon kayan tallafin mu na yanke shawara, Code-HF, zai iya inganta bambance-bambancen marasa lafiya da ake zargi da gazawar zuciya da aka gani a fannonin likitanci daban-daban kuma su canza kulawar su, yana sauƙaƙe ingantaccen ganewar asali.Nazarin da suka gabata sun nuna cewa daidaitaccen lokaci da ingantaccen magani na tushen shaida na marasa lafiya tare da raunin zuciya mai tsanani na iya rage yawan mace-mace da tsawon zaman asibiti, kuma jinkiri yana da alaƙa da sakamako mafi muni.46 Bugu da ƙari, CoDE-HF da aka tattara akai-akai yana amfani da masu canji kuma saboda haka za'a iya shigar da shi cikin ayyukan aiki na asibiti a matsayin wani ɓangare na hanyar ƙaddamar da sashen gaggawa don ba da damar ƙima mai inganci.A halin yanzu, yawancin marasa lafiya da ake zargi da gazawar zuciya suna da echocardiography akan shigar da su don tantance maganin su, amma a ƙarshe an gano wani yanki na marasa lafiya.2 Echocardiography wani ɗan gajeren lokaci ne da ƙwararrun ƙwararrun ƙwararrun albarkatu Muna sa ran yin amfani da CoDE-HF don ƙarin daidaitattun bayanai da amfani da sabis na musamman kamar echocardiography na iya haifar da babban tanadin farashi da inganci ga tsarin kiwon lafiya..Bugu da ƙari, ana iya samun ajiyar kuɗi ta hanyar kula da marasa lafiya marasa lafiya.Ana buƙatar bincike mai yiwuwa a halin yanzu don kimanta ƙimar asibiti da ƙimar ƙimar madaidaicin yanke shawara na CoDE-HF daban-daban a cikin aikin asibiti.
Mun yarda da iyakoki da yawa.Na farko, mun sami damar samun bayanan matakin haƙuri na mutum ɗaya don 14 na karatun 30 waɗanda suka cika ka'idodin cancantarmu, don haka za a iya gabatar da son rai.Koyaya, karatun da suka cancanta waɗanda ba a haɗa su ba suna da irin wannan matsalar rashin ƙarfi na zuciya, kwanakin bugawa, da ɗaukar hoto, kuma yawan jama'a suna da halaye iri ɗaya da na asibiti ga waɗanda aka haɗa.Na biyu, lokacin da aka tattara bayanai daga binciken da yawa, wasu nazarin sun ɓace bayanai don wasu masu canji.Don haɓaka amfani da bayanai, mun yi amfani da tsarin matsayi na ƙima da yawa.Na uku, ba mu yi rikodin bayanan ECG da X-ray na ƙirji ba jere don haɗa su a cikin ƙirarmu.Fassarar NT-proBNP a cikin marasa lafiya da ake zargi da rashin ƙarfi na zuciya ya kamata a yi tare da waɗannan nazarin, 47 da kuma ƙarin nazarin ana buƙatar sanin ko hanyoyin hada waɗannan karatun na iya inganta ƙimar CoDE-HF.Na hudu, ba duk binciken da aka yi ba tare da la'akari da sakamakon gwajin NT-proBNP ba.A cikin binciken mu na hankali, lokacin da muka ware karatu guda biyu tare da ma'anar da ba a rufe ba, babu wani canji a aikin bincike.Na biyar, ƙayyadaddun ganewar asali na rashin ciwon zuciya mai tsanani bai ƙyale bambancewa tsakanin gazawar zuciya tare da raguwar raguwar fitarwa da raunin zuciya tare da ɓangarorin da aka adana.48 Haɓaka haɓakar HF tare da ɓangarorin cirewa a cikin tsofaffi marasa lafiya na iya yin bayanin wasu nau'ikan nau'ikan da aka gani tare da shekaru, amma jagororin yanzu suna ba da shawarar HF tare da rage juzu'in fitar da EF.Rashin gazawar zuciya yana amfani da madaidaicin NT-ProBNP iri ɗaya.58 Na shida, kodayake yawancin karatun sun ci gaba da yin rajistar marasa lafiya tare da dyspnea mai tsanani, yawancin raunin zuciya mai tsanani ya kasance mai girma kuma zaɓin zaɓi na iya kasancewa.Koyaya, tasirin jagororin da aka ba da shawarar yanke yankewar NT-proBNP da iyakokin shekarun ba su canza ba a cikin nazarin hankali, sai dai na karatu tare da babban haɗarin son zuciya.A ƙarshe, m ciwon zuciya ciwo ne na asibiti, kuma ganewar asali kanta yana da rashin tabbas da kuma bambancin bincike.Wannan rashin tabbas na iya zama mafi girma a cikin tsofaffi, wanda zai iya yin bayani a wani ɓangare na bambancin da aka lura a cikin sakamakon bincike.
Mun nuna cewa aikin bincike na ƙimar yankewar NT-proBNP da aka ba da shawarar a cikin jagororin don raunin zuciya mai tsanani ya bambanta a cikin wani muhimmin rukunin marasa lafiya.Mun haɓaka da kuma inganta ƙimar CoDE-HF, wanda ya haɗu da NT-pro-BNP a matsayin ma'auni mai ci gaba tare da masu canji na asibiti don ƙayyade yiwuwar rashin ciwon zuciya mai tsanani a cikin marasa lafiya guda ɗaya ta amfani da samfurin ƙididdiga.Wannan kayan aikin goyan bayan yanke shawara daidai ya yanke hukunci kuma ya kawar da mummunan rauni na zuciya kuma an yi shi akai-akai a cikin duk ƙungiyoyin ƙasa.Ana buƙatar karatu mai yiwuwa a halin yanzu don kimanta tasirin aiwatar da wannan kayan aikin tallafi na yanke shawara akan amfani da albarkatun kiwon lafiya da sakamakon haƙuri.
Binciken cututtukan zuciya mai tsanani na iya zama da wahala saboda marasa lafiya sukan gabatar da alamun da ba na musamman ba.
Yawancin jagororin ƙasa da na ƙasa suna ba da shawarar gwada N-terminal B-type natriuretic peptide precursor (NT-proBNP) don ganewar ciwon zuciya mai tsanani.
Ba a yi amfani da gwajin NT-proBNP a duk duniya ba saboda matsaloli tare da aikin bincike a cikin ƙungiyoyin marasa lafiya masu mahimmanci na asibiti.
Ƙofar NT-proBNP da aka ba da shawarar don rashin gazawar zuciya a cikin jagororin suna da ƙarancin aikin bincike mara kyau a cikin mahimman ƙungiyoyin marasa lafiya.
An haɓaka ingantaccen kayan aikin goyan bayan yanke shawara wanda ya haɗa NT-pro-BNP azaman ma'auni mai ci gaba tare da masu canjin asibiti ta amfani da ƙirar ƙididdiga.
Wannan kayan aikin ya fi dacewa da yanke hukunci kuma ya yanke hukuncin rashin gazawar zuciya fiye da kowace hanya ta amfani da madaidaicin NT-proBNP kaɗai kuma an yi shi akai-akai a duk ƙungiyoyin ƙasa.
An gudanar da duk karatun bisa ga sanarwar Helsinki kuma an amince da su cikin ɗabi'a don ba da damar raba bayanan matakin haƙuri don wannan bincike.
Lambar R da bayanan da ba a san su ba da aka yi amfani da su don haɓakawa da tabbatar da ƙimar CoDE-HF suna samuwa ga masu bincike bisa buƙatar marubucin.