脑利钠肽对ST段抬高型心肌梗死患者的预后价值

The prediction value of brain natriuretic peptide in patients with ST elevation myocardial infarction

目的测定ST段抬高型心肌梗死(STEMI)患者发病24 h的全血脑利钠肽(BNP)浓度,探讨其对STEMI 1年的预测价值。方法入选STEMI患者共82例,应用美国博适-Triage干式快速定量心力衰竭/心肌梗死诊断仪测定患者发病后24 h全血BNP浓度;随访所有患者1年内全因死亡、再发心肌梗死及症状性心衰发生情况,探讨BNP对上述心血管事件的预测价值。结果①STEMI患者发病后24 h全血BNP浓度显著升高;②BNP浓度对STEMI患者1年内全因死亡、再发心肌梗死、症状性心衰及心血管总事件均具有明显的预测价值(ROC曲线下面积分别是:0.92、0.81、0.67、0.84,P值分别是:0.002、0.001、0.041、0.000)。同时取得最大灵敏度和特异度的预测上述指标的BNP理想界值分别是173.61、160.62、158.96及158.96 pg/ml。③平均BNP浓度≥162.70 pg/ml患者无全因死亡、再发心肌梗死、症状性心衰及心血管总事件,生存期分别明显的低于<162.70 pg/ml患者(339 d vs 365 d,P=0.025;306 d vs 352 d,P=0.0009;306 d vs 352 d,P=0.023;244 d vs 341 d,P=0.000)。结论全血BNP水平可以作为STEMI患者1年内死亡、再发心肌梗死、症状性心衰及总心血管事件的预测指标。

Objective To explore the correlation of brain natriuretic peptide（BNP） and one-year cardiac events in patients after a- cute myocardial infarction. Methods Eighty-two patients with acute ST elevation myocardial infarction（STEMI） were included. Blood samples for measurement of BNP at 24 huors after the onset of STEMI were obtained and clinical events including death, reinfarction and heart failure were recorded during one year of follow-up. Results： （1）Serum levels of BNP become elevated after the onset of STEMI. （2）The level of BNP had the better accuracy to detect death, reinfarction, heart failure and all cardiac events（ AUC ：0. 92,0. 81,0. 67, 0. 84 respectively ;P value：0. 002,0. 001,0. 041,0. 000）, the optimal cutoff value of BNP was 173.61 pg/ml, 160.62 pg/ml, 158.96 pg/ml, 158.96 pg/ml respectively. （3） The survival time of patients with BNP above 162. 70 pg/ml was shorter than that without（339d vs 365d,P =0.025;306 d vs 352 d,P =0. 0009; 306 d vs 352 d,P=0. 023; 244d vs 341 d,P=0.000）. Conclusion The elevation of BNP level in patients with STEMI has better prediction value of one-year cardiac events.