血浆脑钠肽和左室射血分数在急诊经皮冠脉介入术治疗急性冠脉综合征患者预后评估中的作用

Effect of Plasma Brain Natriuretic Peptide and Left Ventricular Ejection Fraction in the Prognosis Evaluation of Patients with Acute Coronary Syndrome Undergoing Emergency Percutaneous Coronary Intervention

目的探讨血浆脑钠肽(BNP)水平联合左室射血分数(LVEF)在急诊经皮冠脉介入术(PCI)治疗急性冠脉综合征(ACS)患者预后评估中的价值。方法选择四川省成都市第六人民医院2016年1月—2017年10月收治的行急诊PCI治疗的ACS患者97例,按照出院前血浆BNP水平及LVEF分为2组,观察组(n=49)以BNP>450 ng/L,LVEF低于50%为标准入组,对照组(n=48)以BNP≤450 ng/L,LVEF高于50%入组,均接受冠心病二级预防措施,术后1月及12月复查LVEF及BNP,并统计相关生化指标及主要心血管不良事件,比较分析BNP及LVEF在两组患者预后评估中的价值。结果两组患者出院前BNP及LVEF均在入组要求范围之内,术后1个月观察组BNP下降,LVEF升高,对照组BNP升高,LVEF降低,组间比较差异无统计学意义(P>0.05),术后12月BNP在观察组出现明显升高,差异有统计学意义(P<0.05),LVEF在观察组明显降低,差异有统计学意义(P<0.05),两组患者术后1个月均有心血管不良事件发生,但分类比较各组间差异无统计学意义(P>0.05),术后12个月观察组发生心血管不良事件例数更多且更为严重,差异有统计学意义(P<0.05)。结论BNP联合LVEF在评估急诊PCI治疗ACS患者预后中能起到警示作用,有助于危险分层,提早做出正确的临床判断,针对高危患者采取有效的干预措施。

Objective To explore the value of plasma brain natriuretic peptide(BNP)level combined with left ventricular ejection fraction(LVEF)in the prognosis evaluation of patients with acute coronary syndrome(ACS)after emergency percutaneous coronary intervention(PCI).Methods 97 ACS patients treated with emergency PCI in the hospital from Jan 2016 to Oct 2017 were divided into two groups according to the plasma BNP level and LVEF before discharge,the observation group(n=49)was enrolled with BNP>450 ng/L and LVEF below 50%,the control group(n=48)was enrolled with BNP≤450 ng/L and LVEF above 50%,and all patients received secondary prevention measures for coronary heart disease,and LVEF and BNP was reexamined for 1 month and 12 months after operation,biochemical indicators and major cardiovascular adverse events were analyzed,The prognostic value of BNP and LVEF in the two groups was compared and analyzed.Results BNP and LVEF of both groups were within the requirements of admission,BNP decreased and LVEF increased in the observation group 1 month after operation,while BNP increased and LVEF decreased in the control group,there was no statistical difference(P>0.05),BNP increased significantly in the observation group in 12 months after operation,there was significant statistical difference(P<0.001),LVEF decreased significantly in the observation group,there was statistical difference(P<0.05),Cardiovascular adverse events occurred in both groups 1 month after operation,but there was no significant difference(P>0.05),the number of cardiovascular adverse events was more and more serious in the observation group in 12 months after operation,and the difference was statistically significant(P<0.05).Conclusion BNP combined with LVEF can play a warning role in evaluating the prognosis of patients with ACS treated by emergency PCI,It is helpful for risk stratification,making correct clinical judgment early and taking effective intervention measures for high-risk patients.