脑钠肽与高龄患者支架置入术预后的关系

Relationship between B-type natriuretic peptide and prognosis of stent implantation in elderly patients

目的研究术前脑钠肽(BNP)水平与高龄不稳定型心绞痛(UAP)患者冠状动脉介入术(PCI)后全因死亡的预测价值。方法该研究为回顾性研究,连续入选长海医院于2015年1月至12月行PCI治疗且年龄≥75岁的UAP患者311例,收集其临床资料,随访终点为全因死亡或术后2年。根据术前BNP水平将患者分为BNP<100 pg/ml组(n=197),100 pg/ml≤BNP<300 pg/ml组(n=71),和BNP≥300 pg/ml组(n=43)。绘制Kaplan-Meier生存曲线;采用Cox比例风险回归模型分析BNP对高龄PCI患者预后的影响。结果平均随访22.6±4.3月,术后6月、1年和2年累积全因死亡率分别为1.3%、4.2%和8.5%。与另两组比较,BNP≥300 pg/ml组陈旧性心肌梗死病史、NYHA心功能Ⅲ/Ⅳ级患者较多,血肌酐更高,差异有统计学意义(P均<0.05)。BNP<100 pg/ml组、100 pg/ml≤BNP<300 pg/ml组和BNP≥300 pg/ml组术后2年全因死亡率分别为4.4%、9.9%和25.6%,差异有统计学意义(P<0.05)。多因素Cox回归分析显示,在校正了包括年龄、性别、NYHA心功能Ⅲ/Ⅳ级、血红蛋白等因素后,BNP≥300 pg/ml(RR=4.822,95%CI:2.183~10.650)、血肌酐≥110μmol/L(RR=2.930,95%CI:1.327~6.468)均是高龄UAP患者全因死亡的独立危险因素。结论术前BNP水平与高龄UAP患者PCI预后相关,BNP≥300 pg/ml的患者全因死亡风险较大。

Objective To study the preoperative level of B-type natriuretic peptide(BNP)and its predictive value to post-operation all-cause mortality in elderly patients with unstable angina pectoris(UAP)after PCI.Methods UAP patients(aged≥75,n=311)undergone PCI were retrospectively chosen from Changhai Hospital from Jan.2015 to Dec.2015,and their clinical data was collected.The endpoint of follow-up was mortality or 2 y after PCI.The patients were divided,according to preoperative level of BNP,into normal group(BNP<100 pg/ml,n=197),mild-high BNP group(100 pg/ml≤BNP<300 pg/ml,n=71)and high BNP group(BNP≥300 pg/ml,n=43).Kaplan-Meier survival curve was drawn,and influence of BNP on prognosis was analyzed by using Cox proportional hazard regression model in elderly patients after PCI.Results The average follow-up time was(22.6±4.3)months,and all-cause mortality was 1.3%,4.2%and 8.5%respectively 6 months,1 y and 2 y after PCI.The patients with history of old myocardial infarction(OMI)and NYHA gradeⅢorⅣwere more,and serum creatinine(SCr)level was higher in high BNP group compared with other 2 groups(all P<0.05).The all-cause mortality was 4.4%in normal group,9.9%in mild-high BNP group and 25.6%in high BNP group(P<0.05)after PCI for 2 y.The results of multi-factor Cox regression analysis showed that,after correcting age,sex,NYHA gradeⅢorⅣand hemoglobin(Hb),BNP≥300 pg/ml(RR=4.822,95%CI:2.183~10.650)and SCr≥110μmol/L(RR=2.930,95%CI:1.327~6.468)were the independent risk factor of all-cause mortality in elderly patients with UAP.Conclusion The preoperative level of BNP is related to prognosis in elderly patients with UAP after PCI,and those with BNP≥300 pg/mL have higher risk of all-cause mortality.