NT-proBNP对老年稳定型冠心病患者未来不良心脏事件风险评估价值

The significance of serum NT-proBNP for the future risk evaluation of major adverse cardiac events in elderly patients with stable coronary artery disease

目的探讨氨基末端B型钠尿肽原(NT-proBNP)对老年稳定型冠心病(SCAD)患者未来主要不良心脏事件(MACE)风险评估的价值。方法将810例老年SCAD患者按随访期内病情转归情况分为非MACE组468例、MACE组342例(包括心源性再入院组200例、非致死急性心肌梗死(AMI)组61例、死亡组81例);按MACE发生时间顺序分为近期MACE组180例和远期MACE组162例。采用双向侧流免疫法检测所有入选患者和40名健康对照者以及入选患者随访期间的第3个月、第6个月及第12个月血清NT-proBNP水平,并进行统计学分析。对患者平均随访24个月,观察随访期间发生的MACE。结果初次住院时,MACE组及非MACE组NT-proBNP水平明显高于对照组(P<0.01);MACE组NT-proBNP水平高于非MACE组(P<0.01),近期MACE组高于远期MACE组(P<0.05);死亡组及非致死AMI组NT-proBNP水平明显高于再入院组(P<0.05)。且NT-proBNP水平与患者再入院和发生AMI的时间呈负相关[r值分别为-0.359(P=0.00)、-0.458(P=0.026)]。随着NT-proBNP水平的增高,不同NT-proBNP水平组的MACE发生率相应增高,除NT-proBNP>6 000 ng/L组外,其余各组MACE发生率差异有统计学意义(P<0.01)。MACE组发生MACE前的NT-proBNP峰值水平明显高于非MACE组。死亡组NT-proBNP峰值水平明显高于其他组(P<0.05、P<0.01)。在随访第3个月、第6个月及第12个月,MACE组NT-proBNP水平均高于初次进院时(P<0.01);非MACE组患者NT-proBNP水平明显低于初次进院时(P<0.01),亦明显低于MACE组(P<0.01)。Kaplan-Meier曲线分析表明,不同NT-proBNP水平组患者的生存率差异有统计学意义(P<0.01)。合并不同疾病死亡组患者血清NT-proBNP水平比较差异无统计学意义(P>0.05)。结论老年SCAD患者未来MACE发生率及其发生时间与初入院时NT-proBNP水平、随访期内NT-proBNP动态变化及其峰值水平密切相关。NT-proBNP检测对老年SCAD未来MACE风险评估有较高的预测价值。

Objective To investigate the significance of serum N-terminal pro-B-type natriuretic peptide（NTproBNP） for the future risk evaluation of major adverse cardiac events（MACE） in elderly patients with stable coronary artery disease（SCAD）.Methods A total of 810 elderly patients with SCAD were classified into non-MACE group（468 cases） and MACE group [342 cases,including cardiogenic readmission group（200 cases）,nonfatal acute myocardial infarction（AMI） group（61 cases） and death group（81 cases） ] according to disease prognosis.The 342 cases of MACE group were classified into the short-term MACE group（180 cases） and the long-term MACE group（162 cases）.The serum NT-proBNP levels of 40 healthy controls and 810 elderly patients with SCAD,which were followed up in the third month,in the sixth month and in the twelfth month,were determined by bi-directional lateral flow immunoassay.The results were analyzed statistically.The MACE were followed up and observed for an average of 24 months.Results The serum NT-proBNP levels at initial admission in the MACE group and non-MACE group were significantly higher than those in the control group（P〈0.01）,the serum NT-proBNP levels at initial admission in the MACE group were significantly higher than those in the non-MACE group（P〈0.01）,the serum NT-proBNP levels at initial admission in the short-term MACE group were significantly higher than those in the long-term MACE group（P〈0.05）,and the serum NT-proBNP level at initial admission in the death group and nonfatal AMI group were significantly higher than those in the cardiogenic readmission group（P〈0.05）.The serum NT-proBNP levels at initial admission were negatively correlated with the interval time of the patients with readmission and AMI [r =-0.359（P = 0.000）,r =-0.458（P = 0.026） ].The serum NT-proBNP level was higher,and the incidence rates of MACE were higher.The incidence rates of MACE in different serum NT-proBNP level groups were significantly different（P〈0.01）,except the NT-proBNP 6 000 ng/L group.Before MACE,the top value of serum NT-proBNP in the MACE group was significantly higher than that in the non-MACE group,and the top value of serum NT-proBNP in the death group was significantly higher than that in the other groups（P〈0.05,P〈0.01）.In the third,sixth and twelfth months of follow-up period,the serum NT-proBNP levels in the MACE group were significantly higher than those at initial admission（P〈0.01）.The serum NT-proBNP levels in the non-MACE group were significantly lower than those at initial admission（P〈0.01）,and were significantly lower than those in MACE group（P〈0.01）.Kaplan-Meier curve showed that the survival rate with different serum NT-proBNP levels had statistical significance（P〈0.01）.The death group with various diseases had no statistical significance for the serum NT-proBNP levels（P〈0.05）.Conclusions The incidence rate of MACE and the interval time of the MACE in elderly patients with SCAD are closely correlated with the serum NT-proBNP level at initial admission and with the changes of serum NT-proBNP levels and the top value of serum NT-proBNP in the follow-up period.The serum NT-proBNP determination for the MACE risk evaluation in elderly patients with SCAD has an important prognostic significance.