摘要
目的探讨急诊床旁检测N末端B型利钠肽（NT—proBNP）对急性冠脉综合征（ACS）患者院内主要不良心血管事件（MACE）的预测价值。方法急诊ACS患者164例，其中非ST段抬高型ACS（NSTEACS）83例；ST段抬高型ACS（STEACS）81例。人急诊10min内床旁检测NT—proB-NP等生物标记物水平，症状发作距床旁检测平均时间（6．73±6．57）h。记录急诊至心脏科再灌注前发生的院内MACE，包括：急性心力衰竭（AHF）、室性心律失常伴血流动力学不稳（VA）和全因死亡（ACD）。根据有无发生院内MACE分为A组和B组，将组间比较差异有统计学意义的指标经单因素分析判断其与院内MACE的相关性，再将显著相关指标通过Logistic回归筛选独立预测因子，并以ROC曲线下面积（AUC）评价其对院内MACE的预测效能。结果入选病例共发生院内MACE53例（32．32％），死亡11例（6．71％）。A组与B组NT—proBNP水平（10533．11±9346．76）pg／mLV8．（457．75±448．77）pg／mL，P〈0．001。单因素分析显示：年龄、心率、cTnI、Myo、NT—proBNP、Fib、D—dimer、WBC、CRE、UA升高与ACS患者院内MACE相关（P〈0．05）。Logistic回归显示：NT—proBNP是ACS患者院内MACE的独立预测因子（P〈0．001，OR=1．003，95％CI1．001—1．005）。NT—proBNP预测院内MACE的AUC为0．973（95％CI0．942—1．000），界值为2016pg／mL（敏感度0．943，特异度1．000，阴性预测值0．974，阳性预测值1．000）；预测院内MACE中单一终点事件AHF、VA和ACD的AUC分别为0．983（95％c10．960—1．000）、0．916（95％c10．830-1．000）和0．961（95％CI0．932—0．990），界值分别为2016pg／mL、5817pg／mL．和8072pg／mL。结论急诊早期NT—proBNP床旁检测可快速、高效、准确地独立预测再灌注前ACS患者院内MACE，当检测值大于2016pg／mL、5817pg／mL和8072pg／mL时可分别预警院内AHF、VA和ACD。
Objective To investigate the predictive value of POCT of NT - proBNP for in - hospi- tal major adverse cardiovascular events （MACE） among ER patients with acute coronary syndrome （ACS）. Methods 164 patients diagnosed as ACS were selected, including 83 cases of non - ST segment elevated ACS（NSTEACS） and 81 cases of ST segment elevated ACS （STEACS）. The levels of NT - proBNP and other bio - markers of all the patients were measured within 10 minutes after ER admitting. The average length of time from acute attack to POCT was （6.73±6.57）hours. The recorded in - hospital MACE before reperfusion therapy included acute heart failure （AHF）, ventricular arrhythmias with hemodynamic insta- bility （VA） and all - cause death （ACD）. The patients were divided into 2 groups： patients with in - hos- pital MACE （group A） and patients without in - hospital MACE （group B）. The correlation between the in - hospital MACE and the clinical index which had significant difference between the two groups was judged by the single factor analysis. The significant correlation index was analyzed by the Logistic regression to screen the independent risk factor. The area under receiver operating characteristic curve （AU- ROC） was used to evaluate the prediction efficiency of independent risk factor for the in - hospital MACE. Results There were 53 cases of in - hospital MACE （32.32%）, 11 cases of death （6.71%）. The NT - proBNP levels of group A and B were （ 10 533.11 ±9346.76） pg/mL vs. （457.75±448.77）pg/mL （P 〈 0.001 ）. The single factor analysis showed that age, heart rate, cTnI, Myo, NT - proBNP, Fib, D - dimer, WBC, CRE, UA were associated with in - hospital MACE in patients with ACS （P 〈 0.05 ）. Logistic regression analysis showed that NT - proBNP （P 〈 0.001, OR = 1.003, 95%CI： 1.001 ± 1.005） was an independent predictive factor. By using NT - proBNP for predicting in - hospital MACE, the AUROC was 0.973 （95%CI： 0.942 ± 1.000）, the cutoff value was 2016 pg/mL （sensitivity： 0.943, specificity： 1.000, negative predictive value： 0.974, positive predictive value： 1.000）. For predicting the single end events AHF, VA and ACD, the AUROCs were respectively 0.983 （95%CI： 0.960 ± 1.000）, 0.916 （95% CI： 0.830 ± 1.000） and 0.961 （95%CI： 0.932 ± 0.990）; the cutoff values were respectively 2016 pg/mL, 5817 pg/mL and 8072 pg/mL. Conelusion POCT of NT - proBNP is a fast, efficient and accurate way to predict the in - hospital MACE independently among emergency patients with ACS before reperfu- sion. When NT - proBNP levels are respectively greater than 2016 pg/mL, 5817 pg/mL and 8072 pg/mL, the in - hospital AHF, VA and ACD should be alerted.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第4期346-351,共6页
Chinese Journal of Critical Care Medicine
作者简介
闫博（1982-），男，住院医师。
通信作者：秦俭（1953-），男，主任医师，教授，硕士研究生导师，E-mail：jqin6@163．com。
