超声心室壁应力联合血清BNP水平对UAP患者PCI术后预后的预测价值

Predictive value of ultrasound ventricular wall stress combined serum BNP level for prognosis in UAP patients after PCI

目的:研究超声心室壁应力联合血清脑钠肽(BNP)水平对不稳定型心绞痛(UAP)患者PCI术后预后不良的预测价值。方法:依据预后情况,于我院行PCI术的280例UAP患者被分为预后不良组(45例)与预后良好组(235例),比较两组一般临床资料、超声心室壁应力、血清BNP水平;分析PCI术后预后不良的危险因素及超声心室壁应力联合血清BNP水平对PCI术后预后不良的预测价值。结果:与预后良好组比较,预后不良组超声心室壁应力,血清BNP水平,年龄,BMI,合并高血压、糖尿病、高脂血症比例,有吸烟史、饮酒史比例,Gensini积分均显著升高(P均=0.001)。多因素Logistic回归分析显示,年龄,BMI,合并高血压、糖尿病、高脂血症,有吸烟史、饮酒史,Gensini积分,超声心室壁应力,血清BNP水平均为UAP患者PCI术后预后不良的独立危险因素(OR=1.154~3.982,P<0.05或<0.01)。ROC曲线分析显示,超声心室壁应力,血清BNP水平单独检测及二者联合检测预测UAP患者PCI术后预后不良的曲线下面积(AUC)分别为0.725、0.693、0.834,灵敏度分别为60.00%、66.67%、100.00%,特异度分别为83.83%、83.40%、83.40%,两项联合检测的AUC,灵敏度均显著高于各项单独预测(P<0.05或<0.01)。结论:超声心室壁应力、血清BNP水平为UAP患者PCI术后预后不良的独立危险因素,且二者联合预测对PCI术后预后不良具有较高预测价值。

Objective:To study predictive value of ultrasound ventricular wall stress(UVWS)combined serum brain natriuretic peptide(BNP)level for prognosis of patients with unstable angina pectoris(UAP)after percutaneous coronary intervention(PCI).Methods:According to prognosis,a total of 280 UAP patients undergoing PCI in our hospital were divided into poor prognosis group(n=45)and good prognosis group(n=235).General clinical data,UVWS and serum BNP level were compared between two groups;and risk factors for poor prognosis after PCI and predictive value of UVWS combined serum BNP level for poor prognosis after PCI were analyzed.Results:Compared with good prognosis group,there were significant rise in UVWS,serum BNP level,age,BMI,percentages of hypertension,diabetes mellitus(DM),hyperlipidemia,smoking history and drinking history,and Gensini score in poor prognosis group(P=0.001 all).Multivariate Logistic regression analysis indicated that age,BMI,percentages of hypertension,DM and hyperlipidemia,smoking history and drinking history,Gensini score,UVWS and serum BNP level were independent risk factors for poor prognosis in UAP patients after PCI(OR=1.154~3.982,P<0.05 or<0.01).ROC curve analysis indicated that areas under curve(AUC)of UVWS,serum BNP level and their combined detection for predicting poor prognosis in UAP patients after PCI was 0.725,0.693 and 0.834 respectively,sensitivity was 60.00%,66.67% and 100.00% respectively;specificity was 83.83%,83.40% and 83.40%respectively;AUC and sensitivity of combined detection were significantly higher than those of single detections(P<0.05 or<0.01).Conclusion:Ultrasound ventricular wall stress and serum BNP level are independent risk factors for poor prognosis after PCI in patients with unstable angina pectoris,and dual-detection possesses higher predictive value for poor prognosis after PCI.