N末端B型钠尿肽前体对高龄急性冠状动脉综合征患者预后评估的价值

Value of NT-proBNP for assessing the outcome in very old ACS patients

目的探讨血浆N末端B型钠尿肽前体(NT-proBNP)对高龄急性冠状动脉综合征(ACS)患者病情及预后评估的价值。方法回顾性选择2011年1月~2016年1月中国医学科学院阜外医院因ACS住院治疗的高龄患者338例,根据NT-proBNP水平分为高水平组84例(NT-proBNP≥1228.7 ng/L)和低水平组(NT-proBNP<1228.7 ng/L)254例。检测基线NT-proBNP水平,计算全球急性冠状动脉事件注册(GRACE)评分。观察出院后1年及长期随访期间主要不良心血管事件(MACE)发生情况。结果高水平组NT-proBNP、GRACE评分、GRACE评分高危比例明显高于低水平组,差异有统计学意义(P<0.01)。Spearman相关性分析显示,NT-proBNP水平与高龄ACS患者GRACE评分呈正相关(r=0.341,P<0.01)。ROC曲线分析显示,NT-proBNP能预测高龄ACS患者短期和长期MACE风险(P<0.05,P<0.01)。短期随访中发生MACE 24例(7.4%),长期随访中发生MACE 152例(49.2%)。Kaplan-Meier生存曲线显示,高水平组短期及长期随访MACE累积发生率明显高于低水平组,差异有统计学意义(P_(log rank)<0.01)。多因素Cox回归分析显示,调整相关因素后,高水平NT-proBNP与高龄ACS患者短期及长期随访MACE发生风险独立相关(HR=2.841,95%CI:1.172~6.884,P=0.021;HR=1.653,95%CI:1.138~2.399,P=0.008)。结论高水平NT-proBNP是高龄ACS患者短期及长期MACE的独立预测因素。

Objective To study the value of serum NT-proBNP level for assessing the condition and outcome in very old ACS patients.Methods Three hundred and thirty-eight very old ACS patients admitted to our hospital from January 2011 to January 2016 were divided into high serum NT-proBNP level(≥1228.7 ng/L)group(n=84)and low serum NT-proBNP level(<1228.7 ng/L)group(n=254).The baseline serum NT-proBNP level was measured,the GRACE score and incidence of MACE at 1 year after discharge and during the long-term follow-up period were recorded in two groups.Results The serum NT-proBNP level and GRACE score were significantly higher in high serum NT-proBNP level group than in low serum NT-proBNP level group(P<0.01).Spearman correlation analysis showed that the serum NT-proBNP level was positively related with the GRACE score in very old ACS patients(r=0.341,P<0.01).ROC curve analysis displayed that NT-proBNP could predict the short-and long-term risk of MACE in very old ACS patients(P<0.05,P<0.01).MACE occurred in 24 very old ACS patients(7.4%)during the short-term follow-up period and in 152 very old ACS patients(49.2%)during the long-term follow-up period.Kaplan-Meier survival curve analysis revealed that the cumulative incidence of MACE was significantly higher in high serum NT-proBNP level group than in low serum NT-proBNP level group during the short-and long-term follow-up periods(P_(log rank)<0.01).Multivariate Cox regression analysis demonstrated that high serum NT-proBNP level was an independent risk factor for MACE in very old ACS patients during the short-and long-term follow-up periods(HR=2.841,95%CI:1.172-6.884,P=0.021;HR=1.653,95%CI:1.138-2.399,P=0.008).Conclusion High serum NT-proBNP level is an independent risk factor for MACE in very old ACS patients during the short-and long-term follow-up periods.