入院即刻N末端B型利钠肽原对不稳定性心绞痛患者左心室射血分数和院内主要不良心脑血管事件的预测价值

Predictive value of NT-proBNP on admission on left ventricular ejection fraction and in-patients major adverse cardiac and cerebrovascular events in hospitalized patients with unstable angina

目的 探讨入院即刻N末端B型钠尿肽原(NT-proBNP)对不稳定性心绞痛患者左心室射血分数(LVEF)和院内主要不良心脑血管事件(MACCE)的预测价值.方法 回顾性连续入选2013年1月至2017年9月于北京友谊医院心内科住院的不稳定性心绞痛患者2 972例,按入院即刻血浆NT-proBNP四分位水平分为4组,即NT-proBNP<61 ng/L组(733例)、61 ng/L≤NT-proBNP<133 ng/L组(749例)、133 ng/L≤NT-proBNP<326 ng/L组(747例)和NT-proBNP≥326ng/L组(743例).收集入选者的相关临床资料.比较各组患者LVEF水平和院内MACCE发生情况.采用多因素logistic回归分析NT-proBNP对不稳定性心绞痛患者LVEF和院内MACCE的预测价值.结果 随着NT-proBNP水平升高,患者LVEF降低[NT-proBNP<61 ng/L组、61 ng/L≤NT-proBNP<133 ng/L组、133 ng/L≤NT-proBNP<326 ng/L组和NT-proBNP≥326 ng/L组患者LVEF分别为(68.4±4.8)%、(68.2±5.2)%、(67.2±6.7)%和(62.6±10.4)%,F=77.98,P<0.01].随着NT-proBNP水平升高,院内MACCE发生率升高[NT-proBNP<61 ng/L组、61 ng/L≤NT-proBNP<133 ng/L组、133 ng/L≤NT-proBNP<326 ng/L组和NT-proBNP≥326 ng/L组患者院内MACCE发生率分别为3.4%(25/733)、3.5%(26/749)、5.5%(41/747)和7.3%(54/743),x2=16.23,P<0.01].多因素logistic回归分析结果显示,NT-proBNP是LVEF<50%的独立预测因子[Exp(β)=5.875,95%CI 3.382~10.207,P<0.001],但不是院内MACCE的独立预测因子[Exp(β)=0.783,95 %CI 0.400~1.996,P=0.783].结论 入院即刻血浆NT-proBNP水平是不稳定性心绞痛患者LVEF的独立预测因子,但不是院内MACCE的独立预测因子.

Objective To explore the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on admission on left ventricular ejection fraction (LVEF) and the in-hospital major adverse cardiac and cerebrovascular events (MACCE) in hospitalized patients with unstable angina (UA).Methods Data of 2 972 consecutive hospitalized patients with UA in Beijing Friendship Hospital from January 2013 to September 2017 were retrospective analyzed.Patients were divided into 4 groups according to the level of NT-proBNP on admission:733 cases with NT-proBNP lower than 61 ng/L,749 cases with NT-proBNP between 61 and 133 ng/L,747 cases with NT-proBNP between 133 and 326 ng/L,and 743 cases with NT-proBNP higher than 326 ng/L.LVEF and in-hospital MACCE were compared among 4 groups and the predictive value of NT-proBNP on admission on LVEF and in-hospital MACCE was determined by multiple logistical regression analysis.Results LVEF value became lower with increasing on admission NT-proBNP value ((68.4± 4.8) %,(68.2 ± 5.2)%,(67.2 ± 6.7)% and (62.6± 10.4)%,F=77.98,P<0.0 1),while in-hospital MACCE was higher with increasing on admission NT-proBNP value (3.4% (25/733),3.5% (26/749),5.5%(41/747)and 7.3% (54/743),χ^2=16.23,P<0.01) in NT-proBNP lower than 61 ng/L,NT-proBNP between 61 and 133 ng/L,NT-proBNP between 133 and 326 ng/L,and NT-proBNP higher than 326 ng/L group.Multiple logistic regression analysis showed that on admission NT-proBNP was an independent predictor for LVEF<50% (Exp(β)=5.875,95%CI 3.382-10.207,P<0.001),but not predictor for in-hospital MACCE (Exp(β) =0.783,95%CI 0.400-1.996,P=0.783).Conclusion The on admission NT-proBNP level is an independent predictor of left ventricular systolic dysfunction (LVEF<50%),but not an independent predictor of total in-hospital MACCE in hospitalized patients with UA.