GRACE评分和中性粒细胞联合应用对急性冠脉综合征患者预后的预测

Prediction of the prognosis of patients with acute coronary syndrome by GRACE score combined with neutrophil

目的 :观察和分析全球急性冠状动脉事件注册评分(GRACE评分)和中性粒细胞联合应用对急性冠脉综合征(ACS)患者预后的预测价值。方法 :选取100例ACS患者,对其临床特征、GRACE评分及N末端脑钠肽前体(NT-pro BNP)水平、中性粒细胞计数、肌钙蛋白(c Tn I)及血脂水平进行观察和比较。结果 :ACS患者的总生存期(OS)与吸烟史(HR=1.832)、急性ST段抬高型心梗(HR=2.367)、急性非ST段抬高型心梗(HR=1.754)、应用ACEI/ARB(HR=0.751)、应用醛固酮受体拮抗剂(HR=0.633)、GRACE评分(HR=3.927)、NT-pro BNP水平(HR=2.136)、中性粒细胞计数(HR=2.845)、c Tn I水平(HR=1.745)等因素具有相关性,GRACE评分和中性粒细胞计数预测ACS远期死亡的用受试者工作特征曲线下面积(AUC)分别为0.854和0.715,高于NT-pro BNP水平和c Tn I水平,联合应用两个指标预测ACS远期死亡的AUC可达到0.927。结论 :ACS患者的预后与多种因素具有相关性,将GRACE评分和中性粒细胞联合应用,可提高针对ACS患者预后的预测效果。

Objective To observe and analyze the value of combined application of Global Registry of Acute Coronary Events(GRACE) score and neutrophil in prediction of the prognosis of patients with acute coronary syndrome(ACS). Methods 100 patients with ACS were selected. The clinical characteristics, GRACE score and the N-terminal pro brain natriuretic peptide(NT pro BNP), the neutrophil count, the troponin(c Tn I) and the blood lipids were observed and compared. Results The overall survival(OS) of the patient with ACS was correlated with the smoking history(HR=1.832), the acute ST elevation myocardial infarction(HR=2.367), the non ST segment elevation acute myocardial infarction(HR=1.754), the application of ACEI/ARB(HR=0.751), the application of aldosterone receptor antagonist(HR=0.633), GRACE score(HR=3.927), NT-pro BNP(HR=2.136), neutrophil count(HR=2.845), c Tn I(HR=1.745). Areas under the receiver operating characteristic curve(AUC) of GRACE score and neutrophil count in prediction of long-term mortality of patients with ACS were 0854 and 0.715, and higher than that of NT-pro BNP level or c Tn I level. AUC of combined application of the two indicators in prediction of long-term death of patients with ACS achieved 0.927. Conclusions The prognosis of patients with ACS has correlation with many factors, and the combination of GRACE score and neutrophil can improved the effects in prediction of the prognosis of ACS patients.