血清NT-proBNP与hs-CRP在预测急性ST段抬高性心肌梗死主要心脏不良事件的价值

Clinical Value of Serum NT-proBNP and hs-CRP in Predicting Major Adverse Cardiac Events for Patient with Acute ST-segment Elevation Myocardial Infarction

目的：探讨血清N末端脑钠肽前体（NT-pro BNP）及超敏C反应蛋白（hs-CRP）在预测急性ST段抬高性心肌梗死（STEMI）近期主要心脏不良事件（MACE）的价值。方法：选取172例STEMI患者为研究对象,按照住院期间是否发生MACE分为MACE组（n=56例）和非MACE组（n=116例）,记录两组之间的入院时血清NT-pro BNP及hs-CRP水平及一般临床资料及实验室检查指标,将NT-pro BNP及hs-CRP水平按照四分位分组（Q1、Q2、Q3和Q4组）,比较各组相关指标的差异,用多因素Logistic回归模型分析NT-pro BNP及hs-CRP水平与MACE发生的关系,用ROC曲线评价血清NT-pro BNP及hs-CRP预测MACE发生的价值。结果：MACE组和非MACE组在血清NT-pro BNP及hs-CRP存在显著的统计学差异（P〈0.05）,MACE组两指标高于非MACE组;两者四分位分组之间MACE发生率存在统计学差异（P〈0.05）,NT-pro BNP Q4组和hs-CRP Q4组中的MACE发生率高于NT-pro BNP Q1-Q2组及hs-CRP Q1-Q2组;多因素Logistic回归分析显示血清NT-pro BNP及hs-CRP是STEMI患者近期MACE发生的独立危险因素,且NT-pro BNP Q1-Q4组及hs-CRP Q1-Q4组之间风险值（OR）逐渐增大。ROC曲线提示血清NT-pro BNP及hs-CRP预测MACE发生的ROCACU分别为：0.887、0.797;灵敏度分别为91.1、85.6;特异度分别为82.6、75.2。结论：血清NT-pro BNP及hs-CRP可能是STEMI患者近期MACE发生的独立危险因素,应当引起临床重视。

Objective： To investigate the clinical value of serum NT-pro BNP and hs-CRP in predicting major adverse cardiac events（MACE） in patient with acute ST-segment elevation myocardial infarction（STEMI）. Methods：Select 172 STEMI patients of our hospital as the research object. According to whether they had MACE during hospital stay, they were divided into MACE group（n=56cases） and the non-MACE group（n=116）. Record the NT-pro BNP and hs-CRP serum levels, general clinical data and laboratory examination indexes on admission. Then patients were subdivided into four groups according to the NT-pro BNP and hs-CRP levels quarterback（Q-1, Q-2, Q-3 and Q-4group）. Compare the difference of related indicators between the groups. Multivariable Logistic regression model was applied to analyze the relationship of NT-pro BNP and hs-CRP levels with MACE. ROC curve was applied to evaluate the value of serum NT-pro BNP and hs-CRP levels in predicting occurrence of MACE. Results： The NT-pro BNP and hs-CRP serum levels had statistically significant differences between MACE group and non-MACE group（P〈0.05）. MACE group had the two index higher than the non-MACE group. The incidence of MACE had statistical differences between quarterback groups（P〈0.05）. The incidence of MACE was higher in the NT-pro BNP Q-4 group and hs-CRP Q-4 group than in the NT-pro BNP Q-1-Q-2groups and hs-CRP Q-1-Q-2groups. Multiariable Logistic regression analysis showed that the serum NT-pro BNP and hs-CRP were independent risk factors for recent MACE of STEMI patients, and the value at risk（OR） increased gradually between NT-pro BNP Q-1-Q-4groups and hs-CRP Q-1-Q-4groups. ROC curve suggested that the MACE prediction ROCACU of serum NT-pro BNP and hs-CRP were respectively 0.887 and 0.797, and the sensitivity respectively 91.1 and 85.6, and specific degree respectively 82.6 and 75.2. Conclusion： Serum NT- pro BNP and hs- CRP may be independent risk factors for STEMI patients with recently occurred MACE.