血浆N末端B型脑钠肽前体与急性ST段抬高型心肌梗死临床预后的相关性

Correlation of plasma N-terminal pro-brain natriuretic peptide with the prognosis of acute ST-segment elevation myocardial infarction

目的探讨血楽N末端B型脑納肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)评估急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的价值。方法 STEMI患者315例,根据入院24h内血浆NT-proBNP水平分为NT-proBNP<66ng/L组164例和NT-proBNP>66ng/L组151例,比较2组临床资料,分析住院期间及出院后3a主要心血管不良事件(major adverse cardiac event,MACE)发生情况及病死率,Cox回归分析多变量与长期预后的关系。结果住院期间NT-proBNP>66ng/L组MACE发生率(31.8%)、病死率(19.2%)高于NT-proBNP<66 ng/L组(18.9%、6.7%),2组比较差异有统计学意义(P<0.05);Kaplan-Meier曲线分析显示,出院后3 a NT-proBNP≥66 ng/L组累积MACE发生率、病死率均高于NT-proBNP<66 ng/L组;Cox回归分析显示Killip分级3~4级(RR=0.961,95%CI:0.928~0.996,P=0.027)、NT-proBNP(R=1.001,95%CI:1.000~1.001,P=0.016)与STEMI患者出院3a内发生MACE相关;NT-proBNP为257.5 ng/L时,其预测STEMI患者出院后3a发生MACE的灵敏性为50.0%,特异性为86.7%。结论血浆NT-proBNP水平与MACE相关;检测血浆NT-proBNP对STEMI的长期预后具有预测价值。

Objective To explore the value of plasma N-terminal pro-bram natnuretic peptide(NT-proBNP) to the prediction of the clinical outcome of acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 315 patients with STEMI were divided into NT-proBNP<66 ng/L group(n= 164) and NT-proBNP≥66 ng/L group(n =151).The clinical data were compared between two groups.The incidence of major adverse cardiac event(MACE) and fatality during hospitalization stay and in 3 years after discharge were recorded.Cox regression analysis was used to analyze the correlation of the multivariable with the long-term prognosis of STEMI.Results The incidence of MACE and fatality during hospitalization stay were significantly higher in NT-proBNP≥66 ng/L group(31.8%,19.2%) than those in NT-proBNP<66 ng/L group(18.9%,6.7%)(P< 0.05).Kaplan-Meier curve showed that the accumulative incidence of MACE and fatality in 3 years after discharge were significantly higher in NT-proBNP≥66 ng/L group than those in NT-proBNP<66 ng/L group.Cox proportional hazards regression analysis Killip 3-4 level(RR = 0.961,95%CI:0.928-0.996,P = 0.027) and NT-proBNP(RR=1.001,95%CI:1.000-1.001,P = 0.016) were independently correlated with the 3-year MACE incidence.When NT-proBNP was 257.5 ng/L,the sensitivity was 50.0%and the specificity was 86.7%for MACE after 3 years.Conclusion The NT-proBNP level is correlated with MACE,and is valuable to the prediction of long-term prognosis of STEMI.