BNP、LVEF和年龄对非ST段抬高性急性冠脉综合征患者院内恶性室性心律失常的预测价值

Study on the predictive value of BNP,LVEF and Age for malignant ventricular arrhythmia in patients with NSTE-ACS

目的探讨非ST段抬高性急性冠脉综合征(NSTE-ACS)患者院内恶性室性心律失常的预测指标及其价值评估。方法入选506例诊断为不稳定性心绞痛(UAP)或急性非ST抬高性心肌梗死(NSTEMI)的患者,按恶性室性心律失常标准分为四组:正常组(N组,416例),频发室性早搏组(FVPB组,56例),非持续性室性心动过速(组NSVT组,19例),持续性室性心动过速或心室颤动组(SVT/VF组,15例)。因FVPB、NSVT、SVT/VF三组例数偏少,将其合并为恶性室性心律失常组(MVA组,90例)。对比两组患者基线资料及相关指标,行Logistic回归、ROC曲线分析脑钠肽(BNP)、左室射血分数(LVEF)、年龄对NSTE-ACS患者院内MVA的预测价值。结果 1N组、FVPB、NSVT、SVT/VF等四组在性别构成、体重指数、吸烟状况、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(Hb A1c)、高敏肌钙蛋白T(hs TNT)上无统计学差异;四组在年龄(P=0.002)、高敏C反应蛋白(hs CRP)(P<0.001)、BNP(P<0.001)水平上有统计学差异,且数值上依次增加,而四组的LVEF值依次减少(P<0.001)。2N组和MVA组的TC、LDL-C、Hb A1c、hs TNT水平没有统计学差异;MVA组男性比例(P=0.013)、吸烟比例(P<0.001)、年龄(P<0.001)、hs CRP(P<0.001)、BNP(P<0.001)均大于N组,而MVA组体重指数(BMI)(P=0.04)、TG(P<0.001)、LVEF(P<0.001)小于N组。3MVA的多因素Logistic回归分析显示患者年龄、BNP、LVEF与室性心律失常相关,为其独立危险因素。4年龄、LVEF、BNP水平预测院内恶性室性心律失常发生的AUC分别为0.616、0.890、0.908,敏感度分别为47.8%、83.3%、85.6%,特异度分别为72.1%、94.5%、86.5%,最佳截点(cut-off)分别为77.5岁、45.8%、596 pg/ml。三个预测指标的总体准确性,年龄为最差(AUC为0.616),BNP略优于LVEF。结论 BNP升高、LVEF降低与NSTE-ACS患者院内恶性室性心律失常的发生密切相关,且是MVA发生的独立预测因素,具有很好的预测价值,而BNP略优于LVEF。

Objective To explore the significance of predictive indicators for malignant ventricular arrhythmia in patients with NSTE-ACS.Methods A total of 506 patients with NSTE-ACS were selected for this study,they were divided into normal group（ with 416 cases without arrhythmia）,FVPB（ frequent ventricular premature beat） group（ with 56 cases）,NSVT（ nonsustained ventricular tachycardia） group（ with 19 cases）,and SVT / VF（ sustained ventricular tachycardia or ventricular fibrillation） group（ with 15 cases）.Ninety patients in FVPB,NSVT and SVT / VF groups were integrated into MVA（ malignant ventricular arrhythmia） group due to their small sample size.The baseline data and other factors were analyzed between patients without arrhythmia and patients with MVA,then the predictive values of BNP,LVEF and age for malignant ventricular arrhythmia were assessed by Logistic regression and ROC curve analyses.Results 1Patients with MVA had higher levels of hs CRP,BNP,age,rate of males and smoking compared with those of non-arrhythmia patients,the difference was not significant,but levels of BMI,TG and LVEF were lower.2Among these factors by multivariate Logistic regression analysis for MVA,only BNP,LVEF and age were significant.3The respective AUC of age,LVEF and BNP were 0.616,0.890 and 0.908 in predicting the risk of MVA in hospital,and their optimum cut-off points were 77.5 years,45.8% and 596 pg / ml respectively.According to the accuracy of predicting factors,BNP was slightly better than LVEF,the worst was age.Conclusion The high level of BNP and low level of LVEF are closely related with the occurrence of MVA in patients with NSTE-ACS,and they are independent predictive factors to MVA.According to the accuracy of predicting factors,BNP is slightly better than LVEF.