B型尿钠肽对非ST段抬高急性冠状动脉综合征患者冠状动脉病变的预测价值

Prognostic value of B-type natriuretic peptide for coronary disease extension in patients with non-ST-elevation acute coronary syndrome

目的分析非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者B型尿钠肽(BNP)水平与冠状动脉病变程度的相关性,评估BNP对严重冠状动脉病变的预测价值。方法入选发病72h内NSTE-ACS患者115例,测定BNP,计算患者Gensini积分并记录TIMI血流分级和冠状动脉病变支数。按BNP水平分为BNP>80ng/L组和BNP≤80ng/L组,比较各组间资料的差异;分析BNP与Gensini积分的相关性;运用受试者工作特征曲线(ROC),确定诊断严重冠状动脉疾病(Gensini积分>20)的界值,并通过Logistic回归评价该界值的独立相关性。结果非ST段抬高型心肌梗死(NSTEMI)患者BNP水平较不稳定型心绞痛(UAP)患者高(中位数66.4ng/L vs.275.0ng/L,P<0.01),BNP水平随着冠状动脉病变支数的增加而显著升高(均P<0.01)。BNP>80ng/L的患者出现0或1级TIMI血流和严重冠状动脉病变的比例更高(均P<0.01)。BNP与Gensini的相关性良好(r=0.622,P<0.01)。ROC曲线分析后显示,BNP对严重冠状动脉病变有诊断价值[曲线下面积(AUC)=0.867,P<0.05],以BNP=80ng/L为界值时,诊断严重冠状动脉病变的敏感性、特异性和准确度分别为76.7%、79.3%和77.3%,Logistic回归分析BNP>80ng/L是严重冠状动脉病变的独立危险因素(OR=12.039,95%CI:4.153～34.899)。结论 NSTE-ACS患者中,BNP水平能反映冠状动脉病变程度,是诊断严重冠状动脉疾病的优良指标。

Objective To explore the relation between plasma B-type natriuretic peptide(BNP)level and coronary disease extension in patients with non-ST-elevation acute coronary syndrome(NSTE-ACS).Methods Plasma BNP were measured in 115 inpatients with NSTE-ACS which were subdivided according to the number of vessel disease and plasma BNP levels,respectively.Correlation between plasma BNP level and Gensini score was calculated.The receiver operator characteristic curve(ROC curve)was drawn to determine the best threshold for severe coronary artery disease(Gensini score>20).The logistic regression model was used to assess the prognostic contribution of BNP level.Results The BNP level(median 66.4 ng/L vs.275.0 ng/L)were significantly higher in the NSTEMI group than in the UA group(P<0.01).BNP values were progressively increased in relation to the increasing number of vessel disease(all P<0.01).Patients with BNP levels>80 ng/L had a trend toward more frequent occurrence of TIMI 0-1 flow and severe coronary artery disease(23.7% vs.4.7%,P=0.009;91.7% vs.46.5%,P<0.01;respectively).The best prognostic criteria for BNP level(area under curve,0.867)was 80 ng/L determined by ROC(P<0.01).In the logistic regression model,BNP concentration(>80 ng/L,OR=12.039,95% CI:4.153-34.899)was an independent predictor of severe coronary artery disease.Conclusions BNP level is associated with the extension of coronary disease in NSTE-ACS,and the cut-off value of 80 ng/L could offer prognostic value of severe coronary artery disease.