脑钠肽与心房颤动患者远期主要心血管事件的相关性

Correlation between brain natriuretic peptide and long-term major adverse cardiovascular events in patients with atrial fibrillation

目的探讨脑钠肽(brain natriuretic peptide,BNP)与心房颤动患者远期主要心血管事件的相关性。方法连续性入选于2009年10月至2012年10月就诊于佛山市南海区第九人民医院门诊的228例心房颤动患者,对于每个BNP三分位水平都进行无主要心血管事件风险率的评估,并进行多元回归分析BNP三分位水平的主要心血管事件发生的相对危险度。同时将BNP的预测能力与既往的血栓栓塞评分如CHADS2评分进行比较。结果在随访期间,共有58例患者发生了主要心血管事件。无主要心血管事件发生率在最高三分位BNP水平患者中最低(P<0.02)。校正心血管危险因素后,最高三分位BNP水平的危险率(HR)明显高于最低三分位水平(HR=2.38,P<0.02)。在主要心血管事件的预测能力上,血浆BNP的敏感性和特异性均与CHADS2评分相似。将BNP加至CHADS2评分,将提高主要心血管事件的预测能力(P<0.05)。结论血浆BNP检测作为一种简单易测的生物标志物,可单独或与已建立的血栓栓塞评分系统相结合以评估心房颤动患者的主要心血管事件发生风险。

Objectives To evaluate the relationship between plasma brain natriuretic peptide （BNP） and major adverse cardiovascular events （MACE） in atrial fibrillation （AF） subjects.Methods A total of 228 consecutive patients with AF in the Ninth People＇s Hospital of Nanhai District from October 2009 to October 2012 were enrolled.The MACE-free rate within each BNP tertile was estimated,and Cox regression analysis was performed to examine the relative risk of the onset of MACE among the tertiles.The prognostic ability of BNP was compared to an established risk score for embolic events （CHADS2 score）.Results During the follow-up period,58 subjects experienced MACE.The event-free ratio was significantly lower in the highest tertile （P〈0.02）.After adjustment for established MACE risk factors,the hazard ratio （HR） of the highest tertile was significantly higher than that of the lowest tertile （HR=2.38,P〈0.02）.The predictive ability of plasma BNP in terms of sensitivity and specificity for general MACE was comparable to those of CHADS2 score.Adding BNP to the CHADS2 score model could improve the ability for predicting general MACE （P〈0.05）.Conclusions Plasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general MACE risk in AF subjects.