联合应用肌钙蛋白T和N末端B型利钠肽原对老年冠心病患者非心脏手术围手术期心血管事件的预测

Combined Examination of Plasma Levels of TnT and NT-proBNP for Predicting the Risk of Peri-operative Cardiovascular Events in Elder Coronary Artery Disease Patients With Non-cardiac Surgery

目的：通过对老年冠心病患者非心脏手术术前及术后肌钙蛋白T（TnT）和N末端B型利钠肽原（NT-proBNP）的测定，探讨TnT和NT-proBNP联合应用对老年冠心病患者非心脏手术围手术期心血管事件的预测价值。方法：入选60～82岁行择期非心脏手术患者共200例，分冠心病组118例和非冠心病组82例。分别测定术前l天及术后第2天的血清TnT和NT-proBNP浓度，记录两组患者同手术期心血管事件发生情况，探讨TnT和NT-proBNP对心血管事件的预测价值，利用ROC曲线确定最佳界值。结果：（1）冠心病组术后TnT及NT-proBNP浓度均高于术前及非冠心病组同期水平，差异有统计学意义（P均〈0．05）。（2）总的心血管事件在冠心病组显著高于非冠心病组，差异有统计学意义（x^2=5．85，P〈0．05），单项事件比较差异兀统计学意义。（3）冠心病组，术前TnT预测同手术期总心血管事件的最佳界值为18．5ng／L，灵敏度为72．0％，特异度为69．6％；术前NT-proBNP预测围手术期总心血管事件的最佳界值为98．0pg／ml，灵敏度为90．8％，特异度为74．6％。（4）术前TnT升高患者总心血管事件高于TnT正常患者，差异有统计学意义（x^2=4．56，P=0．043），NT-proBNP升高患者总心血管事件同样高于NT-proBNP正常患者，差异有统计学意义（x^2=4．08，P=0．036）。TnT及NT-proBNP均升高患者总心血管事件显著高于两者均正常患者（x^2=13．32，P=0．000）。结论：TnT及NT-proBNP浓度均可作为评估老年冠心病患者非心脏手术同手术期心血管事件的心脏标志物，两者联用预测价值更高。

Objective： To investigate the combined examination of plasma levels of troponin T （TnT） and N-terminal pro-brain natriuretic peptide （NT-proBNP） for predicting the risk of peri-operative cardiovascular events in elder coronary artery disease （CAD） patients with non-cardiac surgery. Methods： A total of 200 patients from （60-82） years of age with elective non-cardiac surgery were enrolled. The patients were divided into 2 groups： CAD group, n=118 and Non-CAD group, n=82. Plasma levels of TnT and NT-proBNP were examined at 1 day before and 2 days after the operation respectively. The cardiovascular events were recorded in both groups and the best cut-off values for TnT and NT-proBNP in risk prediction were evaluated by receiver operating characteristic （ROC） analysis. Results： （1） CAD group had the higher levels of post-operative TnT and NT-proBNP than pre-operative; both TnT and NT-proBNP levels were higher in CAD group than those in Non-CAD group at the same time points, all P〈0.05. （2） The total cardiovascular events in CAD group was higher than those in non-CAD group （x^2=5.85, P=0.016） and the individual event was similar between 2 groups. （3） In CAD group, the best cut-off value for pre-operative TnT in predicting peri-operativecardiovascular events was 18.5 ng/L with the sensitivity at 72% and specificity at 69.6%; for NT-proBNP was 98.0 pg/ml with the sensitivity at 90.8% and specificity at 74.6%. （4） The patients with the higher level ofpre-operative TnT had the increased risk of total cardiovascular events than those with normal TnT （x^2=4.56, P=0.043）, and the same as NT-proBNP （x^2=4.08, P=0.036）. Likewise, the patients with higher levels of both pre-operative TnT and NT-proBNP had the increased risk of total cardiovascular events than those with normal TnT and NT-proBNP （x^2=13.32, P=-0.000）. Conclusion： Either plasma levels of TnT or NT-proBNP could be used as the biomarker for predicting the risk ofperi- operative cardiovascular events in elder CAD patients with non-cardiac surgery, the combined examination would have the better predictive value.