B型利钠肽联合临床指标对急性冠脉综合征患者预后的意义

Prognostic Significance of B-type Natriuretic Peptide Combined with Clinical Indicators in Patients with Acute Coronary Syndrome

目的探讨B型利钠肽(BNP)结合临床指标在急性冠脉综合征(ACS)患者预后评估中的诊断作用。方法选取2018年1月至2019年1月重庆市丰都县人民医院心内科确诊的97例急性冠脉综合征(ACS)患者为研究对象,入院时所有患者均检测血浆BNP水平、左心室射血分数(LVEF),并与40例健康人(对照组)作对照,随访观察1年,记录心脏不良事件(MACE)的发生情况。利用多因素COX风险比例模型分析影响ACS患者预后的独立危险因素。绘制受试者工作特征(receiver operator characteristic,ROC)曲线分析BNP及LVEF等指标,对ACS患者出院后1年的MACE事件进行预测。结果ACS患者的BNP水平明显高于对照组(t=9.057,P<0.05)。与未发生MACE事件的患者相比,发生事件的患者BNP水平显著升高(t=2.953,P<0.05)。多因素COX模型显示,矫正了LVEF和年龄后,BNP>500 pg/mL仍然是预期其1年MACE事件的独立危险因素。ROC曲线显示,BNP对于1年MACE事件的预测能力较好(AUC:0.72),但结合LVEF、年龄后,预测能力显著升高(AUC:0.79),敏感性(73.2%)及特异性(80.0%)也有所提高。结论ACS患者住院期间所测的BNP水平结合LVEF及年龄可以提高其对ACS患者出院后1年MACE时间的预测价值。有效的监测ACS患者血浆BNP水平,对预测病情和评估预后具有重要的临床意义。

Objective To investigate the diagnostic value of B-type natriuretic peptide(BNP)combined with clinical indicators in prognosis evaluation of patients with acute coronary syndrome(ACS).Methods From January 2018 to January 2019,97 patients with ACS diagnosed in the Department of Cardiology of Fengdu People's Hospital of Chongqing were selected as the research objects.Plasma BNP levels and left ventricular ejection fraction(LVEF)were measured in all patients at admission,and compared with 40 healthy people(control group).The patients were followed up for one year,and the incidence of adverse cardiac events(MACE)was recorded.Multivariate COX risk ratio model was used to analyze the independent risk factors affecting the prognosis of ACS patients.Receiver operator characteristic(ROC)curve was drawn to analyze the prediction of mace events by BNP and LVEF in ACS patients one year after discharge.Results BNP level in ACS patients was significantly higher than that in control group(t=9.057,P<0.05).Compared with patients without MACE,BNP levels in patients with MACE events were significantly higher(t=2.953,P<0.05).After adjusting for LVEF and age,BNP>500 pg/mL was still an independent risk factor for MACE events.ROC curve showed that BNP had better prediction ability for one year MACE events(AUC:0.72),but combined with LVEF,age,the predictive ability of BNP was significantly increased(AUC:0.79).The sensitivity(73.2%)and specificity(80.0%)were also improved.Conclusion BNP is an effective predictor of MACE in ACS patients.The combination of LVEF,age and BNP can improve the predictive value of one year MACE in ACS patients.