摘要
目的探讨B型利钠肽(BNP)对非急诊非心脏手术患者的心血管事件的预测价值,并分析相关的危险因素。方法回顾性队列研究。选取2016年1月至2018年12月我院住院收治的行非急诊非心脏手术患者作为研究对象。随访12个月,按照随访中是否发生不良心血管事件(MACE)分为预后不良组(24例)和对照组(212例)。分析BNP与MACE事件的关系。并根据BNP预测MACE的最佳截断点进行亚组分析,Kaplan-Meier生存分析和log-rank检验评估MACE发生率。结果共纳入236例患者,男性162例(68.6%),平均年龄(52.6±20.7)岁。平均随访(11.6±1.6)个月,随访期间,共有24例(10.2%)患者发生MACE,中位发生时间为85 d。其中8例(4.7%)为恶性心律失常,7例(4.1%)为心肌梗死,5例(2.9%)为行再次血运重建,1例(0.6%)支架内血栓,3例(1.8%)因心力衰竭入院,无死亡。两组患者的空腹血糖、肌酸激酶同工酶、BNP、心率等差异均有统计学意义(均为P<0.05)。受试者工作特征曲线显示,血清BNP评估预后的曲线下面积、敏感度、特异度、最大约登指数、最佳截断点分别为0.86(95%CI:0.73~0.91)、87.1%、75.8%、0.61和221.3 pg/ml。根据血清BNP最佳截断点值,将患者再分为高BNP组(59例)和低BNP组(177例),两组分别有13例(22.0%)和11例(6.2%)患者合并MACE事件,较低BNP组,高BNP组的MACE发生率增高2.356倍(HR=3.356,95%CI:1.424~7.909,P=0.006)。结论非急诊非心脏手术患者术后血清BNP与患者术后短期发生MACE密切相关,高血清BNP患者预后较差。
Objective To explore the predictive value of B-type natriuretic peptide(BNP)and related risk factors for cardiovascular events in patients underwent non-emergency non-cardiac surgery.Methods This was a retrospective cohort study.Patients underwent non-emergency non-cardiac surgery in our hospital from January 2016 to December 2018 were included.According to whether adverse cardiovascular events(MACE)occurred during the 12 months of follow-up,they were divided into the poor prognosis group(24 cases)and the control group(212 cases).The relationship between BNP and MACE were analyzed.Kaplan-Meier survival analysis and log-rank test were used to evaluate the risk of MACE in patients with different cut-off point of serum BNP.Results A total of 236 patients were enrolled,including 162 males(68.6%),with an average age of(52.6±20.7)years.The average follow-up was(11.6±1.6)months.During the follow-up,24 patients(10.2%)had MACE,with a median time of 85 d.Among them,8 cases(4.7%)had malignant arrhythmia,7 cases(4.1%)had myocardial infarction,5 cases(2.9%)had revascularization,1 case(0.6%)had stent thrombosis,and 3 cases(1.8%)were admitted to the hospital due to heart failure.The differences between the two groups in fasting blood glucose,creatine kinase(CK)-MB,BNP,and heart rate were statistically significant(all P<0.05).The receiver operating characteristic curve showed that the area under the curve,sensitivity,specificity,maximum Youden index,and best cut-off point of serum BNP were 0.86(95%CI:0.73-0.91),87.1%,75.8%,0.61,and 221.3 pg/ml,respectively.Patients were sub-divided into the high BNP group(59 cases)and low BNP group(177 cases)based on the cut-off point of serum BNP,and MACE in the high BNP group(13 cases,22.0%)was 2.356 times higher than that in the low BNP group(11 cases,6.2%)(HR=3.356,95%CI:1.424-7.909,P=0.006).Conclusions Postoperative serum BNP in patients underwent non-emergency non-cardiac surgery is closely related to the occurrence of MACE,and patients with high serum BNP have a poor prognosis.
作者
王会强
安佰云
周桂玲
潘红
王春燕
任晓晓
Wang Huiqiang;An Baiyun;Zhou Guiling;Pan Hong;Wang Chunyan;Ren Xiaoxiao(Community Health Service Station of Tai’an Road,People’s Hospital of Rizhao,Rizhao 276826,China;Surgery Department,People’s Hospital of Rizhao,Rizhao 276826,China;Department of Surgery,Shibei Branch Hospital,People’s Hospital of Rizhao,Rizhao 276826,China;Department of Cardiology,People’s Hospital of Rizhao,Rizhao 276826,China;Cardiothoracic Surgery Department,People’s Hospital of Rizhao,Rizhao 276826,China;Return Visit Center,People’s Hospital of Rizhao,Rizhao 276826,China)
出处
《中国心血管杂志》
2021年第4期348-351,共4页
Chinese Journal of Cardiovascular Medicine
关键词
非心脏手术
利钠肽
脑
危险因素
不良心血管事件
Non-cardiac surgery
Natriuretic peptide
brain
Risk factor
Cardiac event
作者简介
通信作者:任晓晓,电子信箱:whq0899@126.com。
