血清Copeptin联合GRACE评分对非ST段抬高心肌梗死合并心力衰竭患者预后的评估价值

Prognostic value of serum Copeptin combined with GRACE score in patients with non-ST segment elevation myocardial infarction complicated with heart failure

目的探讨血清和肽素(Copeptin)联合全球急性冠状动脉事件注册(GRACE)评分对非ST段抬高心肌梗死(NSTEMI)合并心力衰竭(HF)患者预后的评估价值。方法选取嘉定区南翔医院急诊ICU科2019年1~12月收治的70例NSTEMI合并HF患者,入院时即刻行血清Copeptin检测,并进行GRACE评分。根据GRACE积分进行危险级别分层,其中低危组(评分<109分)22例,中危组(评分109~140分)25例,高危组(评分>140分)23例。所有患者住院时均行常规治疗,出院后随访180 d,观察指标为再发生主要心脏不良事件(MACE)。比较低危组、中危组和高危组患者以及出院后180 d内再发MACE患者和未发生MACE患者的血清Copeptin及GRACE评分。结果低危组、中危组和高危组患者的血清Copeptin水平分别为(17.59±3.06)pmol/L、(22.76±5.01)pmol/L、(43.04±11.55)pmol/L,Copeptin水平随着GRACE评分的升高而升高,差异均有统计学意义(P<0.05);出院后随访180 d,再发MACE者23例,未发生MACE者47例;再发MACE者血清Copeptin水平为(40.70±12.22)pmol/L,明显高于未发生MACE者的(20.13±4.92)pmol/L,再发MACE者的GRACE评分为(163±12)分,明显高于未发生MACE者的(118±13)分,差异均有统计学意义(P<0.05)。结论血清Copeptin联合GRACE评分对NSTEMI合并HF患者是否再发生MACE的预后评估中具有临床参考价值。

Objective To evaluate the prognostic value of serum Copeptin combined with Global Registry of Acute Coronary Events(GRACE)score in patients with non-ST segment elevated myocardial infarction(NSTEMI)complicated with heart failure(HF).Methods A total of 70 patients with NSTEMI complicated with HF treated in the ICU,Department of Emergency,Nanxiang Hospital of Jiading District of Shanghai,from January to December 2019 were selected.Serum Copeptin was detected immediately on admission,and GRACE score was performed.According to the GRACE score,there were 22 cases in the low risk group(score<109),25 cases in the middle risk group(score 109-140),and 23 cases in the high risk group(score>140).All patients received routine treatment when they were hospitalized,and were followed up for 180 days after discharge.The end point was recurrence of major adverse cardiac events(MACE).The serum Copeptin,GRACE score were compared among the three groups and between the patients with or without recurrence of MACE in 180 days after discharge.Results The serum Copeptin level were(17.59±3.06)pmol/L,(22.76±5.01)pmol/L,(43.04±11.55)pmol/L in low,middle,and high risk groups,respectively,which were increased with the increase of GRACE score(P<0.05).During the follow-up of 180 days after discharge,23 patients had recurrence of MACE and 47 patients did not have MACE.The serum Copeptin level of patients with recurrence of MACE was(40.70±12.22)pmol/L,significantly higher than(20.13±4.92)pmol/L of patients without recurrence of MACE(P<0.05).The GRACE score of patients with recurrence of MACE was(163±12)points,significantly higher than(118±13)points of patients without recurrence of MACE(P<0.05).Conclusion Serum Copeptin combined with GRACE score has clinical reference value in evaluating the prognosis of recurrent MACE in patients with NSTEMI complicated with HF.