摘要
目的探讨急性冠状动脉综合征(ACS)患者早期血清N末端脑钠素前体(NT-proB-NP)水平与长期预后的关系。方法采用ELISA法测定76例ACS患者胸痛发作24～96h[平均(32.8±16.9)h]血清NT-proBNP水平,并随访5年,观察并记录随访期主要心脏不良事件(MACE)。结果 (1)ACS患者血清NT-proBNP水平为(513.51±364.69)pg/ml,中位数为421.5pg/ml。其中急性心肌梗死(AMI)组血清NT-proBNP水平为(679.43±369.05)pg/ml,明显高于不稳定性心绞痛(UAP)组[(329.17±258.51)pg/ml]。(2)NT-proBNP≥421.5pg/ml组发生MACE(包括死亡)明显高于NT-proBNP<421.5pg/ml组。在NT-proBNP水平较高组随访过程中复发性心肌缺血发生率明显高于低值组,分别为30.26%(23例)和7.89%(6例)(P=0.0002);心力衰竭事件发生率分别为15.79%(12例)和2.63%(2例)(P=0.0057);在NT-proBNP水平较高组的患者中病死率高,6例死亡者均分布在高于中位数组,而低于中位数组无死亡。多元Logistic回归分析结果示:NT-proBNP≥421.5pg/ml与随访期MACE发生率有关(OR=19.995,95%CI6.207～64.409)(χ2=25.1894,P=0.0001)。进行生存分析发现,NT-proBNP<421.5pg/ml组的生存曲线高于NT-proBNP≥421.5pg/ml组,而且两条曲线在各时点都没有发生交叉,Log-rank检验P<0.05。(3)NT-proBNP水平对ACS患者长期预后判定的ROC曲线,其曲线下面积(AUC)=0.953,对MACE的阳性预测价值为95.3%,阴性预测价值为4.7%。结论血清NT-proBNP水平是ACS患者5年随访发生MACE的独立预测因素。
Objective To evaluate the correlations of serum N-terminal probrain natriuretic peptide(NT-proBNP)levels and prognosis in patients with acute coronary syndrome(ACS)during 5-year follow-up.Methods Serum NT-proBNP concentrations were measured by ELISA method within 24 96 h[(32.8±16.9)h] after admission in 76 patients with ACS.The patients were followed up for 5-year,the main adverse cardiovascular events(MACE)were observed and recorded.Results(1)Serum NT-proBNP levels was increased in patients with ACS compared with that in patients with unstable angina(P<0.05).The mean value of NT-proBNP concentrations in patients with ACS was(513.51±364.69)pg/ml,the medium value was 421.5 pg/ml.The incidence of MACE was increased in patients whose serum NT-proBNP concentration was higher than the median(P<0.001).(2)The study found that the risk of the group of NT-proBNP≥ 421.5 pg/ml had MACE(including death)was higher than the group of NT-proBNP<421.5 pg/ml.During follow-up,the recurrent incidence of myocardial ischemia in the group of higher NT-proBNP levels was higher than the low group,the rate were 30.26%(23 cases)and 7.89%(6 cases)(P=0.0002);the rate of heart failure event were 15.79%(12 cases)and 2.63%(2 cases)(P=0.0057).The study found that the patients' mortality was higher in group with higher levels of NT-proBNP,the NT-proBNP level of all victims of 6 cases were higher than the median,while if the NT-proBNP level less than the median there was no death.Multivariate logistic regress analysis revealed that NT-proBNP concentration was correlated with the incidence of MACE during follow-up independently(OR=19.995,95% CI 6.207 64.409)(χ2=25.1894,P=0.0001).(3)Area under the curve(AUC)for NT-proBNP≥421.5 pg/ml in evaluating prognosis of ACS patients was 0.953(positive predictive value 95.3%,negative predictive value 4.7%).Conclusions Serum NT-proBNP level is an indepentent predictor for 5-year MACE rate in patients with ACS.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第13期3726-3731,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
急性冠状动脉综合征
利钠肽
脑
预后
心脏不良事件
Acute coronary syndromes
Natriuretic peptide,brain
Prognosis
Main adverse cardiovascular events
