肌钙蛋白、利尿钠肽和C反应蛋白对心脏手术远期疗效的预测价值

Simultaneous measurement of cardiac troponin I, natriuretic peptide, and C-reactive protein for the prediction of long-term cardiac outcome after cardiac surgery

目的 探讨肌钙蛋白、利尿钠肽和C反应蛋白在心脏术后对发生心血管意外的预测价值.方法 2004年10月至2007年1月在同仁医院心外科行心脏手术的患者,共有224例进入该研究,在术前1d,在手术结束当刻和术后6、12、120 h采集患者血样,进行检查.术后对其进行了12个月的随访.严重的心脏意外事件主要包括恶性室性心律失常、心肌梗死、充血性心力衰竭、需要再次行心肌血管重建术意外心源性死亡.应用回归曲线对每种标记物的预测能力进行分析.结果 肌钙蛋白、利尿钠肽和C反应蛋白做为连续性变量对心脏意外事件的发生率有一定的预测能力有限,ROG 曲线下面积分别为0.54[0.47 ～0.60],P =0,42;0.62[0.55～0.68],P=0.01；和0.68[0.61 ～0.74],P＜0.001,C反应蛋白（＞180 mg/L）,利尿钠肽（＞880 pg/ml）,肌钙蛋白（＞3.5 ng/ml）可以做为预测心量不良事件的独立因素,但准确性较低.结论 同时测量肌钙蛋白、利尿钠肽和C反应蛋白可以提高心脏手术后可能发生心脏不良事件预测的能力.

Objective To investigate the clinical value of simultaneous assessment of cardiac troponin I,Btype natriuretic peptide,and C-reactive protein in prediction of long-term cardiac outcome after cardiac surgery.Methods 224 patients undergoing cardiac surgery were included and followed up within 12 months after surgery.Serial blood samples were drawn in all patients the day before surgery,at the end of surgery,and 6,24,and 120h after surgery.Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia,myccardial infarction,congestive heart failure,the need for myocardial revascularization,and/or death from cardiac cause.Predictive ability of each cardiac biomarker was assessed using logistic regression.Results Accuracies of C-reactive protein,cardiac troponin I,and B-type natriuretic peptide,considered as continuous variables to predict the occurrence of major adverse cardiac events were limited（area under receiver operating characteristic curve：0..54[0.47 ～0.60],P =0.42,0.62[0.55 ～0,68],P =0.01,and 0.68[0.61 ～0.74],P ＜0,001,respectively）.When biomarkers were considered as 75％ specificity dichotomized variables,evaluated C-reactive protein（＞ 180mg/L）,cardiac troponin I（＞ 3.5ng/ml）,and B-type natriuretic peptide （＞ 880pg/ml）were independent predictors of major adverse cardiac events（odds ratio：2.14[1.03 ～4.49],P =0.043,2.37 [1.25 ～ 5.64],P =0.011,and 2.65 [1.16 ～ 4.85],P =0.018,respectively） in a multivariate model including the European System for Cardiac Operative Risk Evaluation score.Conclusion Simultaneous measurement of cardiac troponin I,B-type natriuretic peptide,and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.