氨基末端脑钠肽前体对急性心肌梗死患者住院期间预后的预测价值

Predictive value of N-terminal pro-brain natriuretic peptide for short-term prognosis of patients with acute myocardial infarction

目的评价氨基末端脑钠肽前体(NT-proBNP)对急性ST段抬高型心肌梗死患者住院期间预后的预测价值。方法连续入选2005年10月—2007年4月胸痛发作24h之内的急性ST段抬高型心肌梗死住院患者204例,入院后1～3d测定NT-proBNP水平,并记录人口资料、心肌酶学和心肌损伤标志物、心功能指标,记录住院期间2周内心血管事件的发生情况。根据住院期间有无心血管事件(死亡、心源性休克、充血性心力衰竭)分为事件组(54例)和非事件组(150例)。结果与非事件组比较,事件组的NT-proBNP水平显著增高(P<0.05),平均年龄、糖尿病和冠状动脉三支病变构成比均显著增加(P值均<0.05),左心室射血分数(LVEF)、男性和吸烟构成比均显著降低(P值均<0.05)。在预测心血管事件的指标中,NT-proBNP、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)、LVEF、左心室舒张末内径(LVEDD)的受试者工作特性曲线的曲线下面积分别为0.756、0.525、0.536、0.694和0.519,只有NT-proBNP及LVEF有预测价值。将NT-proBNP阈值点定为762fmol/mL时对心血管事件的阳性预测价值为42.7%,阴性预测价值为88.0%,敏感度为75.9%,特异度为63.3%,准确度为66.7%。NT-proBNP>762fmol/mL组(96例)的总心血管事件(42.7%)、心力衰竭(41.7%)、心源性休克发生率(10.4%)和病死率(6.3%)均显著高于NT-proBNP≤762fmol/mL组(108例)的12.0%、12.0%、2.8%和0.9%(P值均<0.05)。单因素分析显示,年龄、女性、糖尿病、吸烟、LVEF、NT-proBNP与预后相关;多元回归分析显示,NT-proBNP、年龄、糖尿病、LVEF是近期发生心血管事件的独立预测因子。结论 NT-proBNP可以预测急性ST段抬高型心肌梗死患者的近期预后。

Objective To evaluate the prognostic performance of N-terminal pro-brain natriuretic peptide （NT-proBNP） in patients with acute ST elevation myocardial infarction（STEMI）. Methods NT-proBNP was obtained from 204 patients with STEMI in Fuwai Hospital within 1 - 3 day after admission. The patients were divided into two groups： Group 1 with cardiac events, including death, cardiogenic shock and heart failure; Group 2 without cardiac events. Death occurred in 7 patients, heart failure occurred in 53 patients, and cardiogenic shock occurred in 13 patients. Results Compared with patients in group 2, NT-proBNP, age, the prevalences of diabetes and multivessel were significantly higher in group 1 （P〈0.05）; and left ventricular ejection fraction （LVEF）, the prevalences of male and smoking rate were significantly lower （P〈0.05）. The areas under ROC curve of NT-proBNP, CK-MB, TnT, LVEF, LVEDD to predict cardiac event were 0.756, 0.525, 0.536, 0.694, and 0. 519, respectively. Only LVEF and NT-proBNP had predictive values for the patients （all P 〈0.01 ）. The optimal cutoff value of NT-proBNP to predict cardiac event was 762 fmol/mL, with a sensitivity of 75.9% and a specificity of 63.3%; the positive predictive value was 42.7% and the negative predictive value was 88.0%, with an accuracy of 66.7%. Patients with NT-proBNP concentration above 762 fmol/mL had a higher rate of cardiac event, heart failure, cardiogenic shock and death （42.7% vs. 12.0%, 41.7% vs. 12.0%, 10.4% vs. 2.8%, and 6.3% vs. 0. 9%, all P〈0.05）. Variables associated with cardiac event in univariate analysis included NT-proBNP, LVEF, age, sex, smoking and diabetes. After adjustment for the above variables using multi regression logistic model, NT-proBNP, age, LVEF, and diabetes remained to be the dependent factors for prediction of cardiac events. Conclusion NT-proBNP can predict the short term outcomes of STEMI patients.