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目的评价氨基末端脑钠肽前体(NT-proBNP)对急性ST段抬高型心肌梗死患者住院期间预后的预测价值。方法连续入选2005年10月—2007年4月胸痛发作24h之内的急性ST段抬高型心肌梗死住院患者204例,入院后1～3d测定NT-proBNP水平,并记录人口资料、心肌酶学和心肌损伤标志物、心功能指标,记录住院期间2周内心血管事件的发生情况。根据住院期间有无心血管事件(死亡、心源性休克、充血性心力衰竭)分为事件组(54例)和非事件组(150例)。结果与非事件组比较,事件组的NT-proBNP水平显著增高(P<0.05),平均年龄、糖尿病和冠状动脉三支病变构成比均显著增加(P值均<0.05),左心室射血分数(LVEF)、男性和吸烟构成比均显著降低(P值均<0.05)。在预测心血管事件的指标中,NT-proBNP、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)、LVEF、左心室舒张末内径(LVEDD)的受试者工作特性曲线的曲线下面积分别为0.756、0.525、0.536、0.694和0.519,只有NT-proBNP及LVEF有预测价值。将NT-proBNP阈值点定为762fmol/mL时对心血管事件的阳性预测价值为42.7%,阴性预测价值为88.0%,敏感度为75.9%,特异度为63.3%,准确度为66.7%。NT-proBNP>762fmol/mL组(96例)的总心血管事件(42.7%)、心力衰竭(41.7%)、心源性休克发生率(10.4%)和病死率(6.3%)均显著高于NT-proBNP≤762fmol/mL组(108例)的12.0%、12.0%、2.8%和0.9%(P值均<0.05)。单因素分析显示,年龄、女性、糖尿病、吸烟、LVEF、NT-proBNP与预后相关;多元回归分析显示,NT-proBNP、年龄、糖尿病、LVEF是近期发生心血管事件的独立预测因子。结论 NT-proBNP可以预测急性ST段抬高型心肌梗死患者的近期预后。
Objective To evaluate the predictive value of NT-proBNP in the prognosis of patients with acute ST-segment elevation myocardial infarction. Methods A total of 204 hospitalized patients with acute ST-elevation myocardial infarction within 24 hours after onset of chest pain from October 2005 to April 2007 were enrolled. NT-proBNP levels were measured 1 to 3 days after admission and the demographic data, And myocardial injury markers, cardiac function indicators, recorded during hospitalization within 2 weeks of cardiovascular events. According to the presence of cardiovascular events (death, cardiogenic shock, congestive heart failure) were divided into event group (54 cases) and non-incident group (150 cases). Results Compared with the non-event group, the NT-proBNP level in the event group was significantly increased (P <0.05), and the mean age, diabetes mellitus and coronary artery disease were significantly increased (P <0.05) (LVEF), male and smoking constitutional ratio were significantly lower (P value <0.05). NT-proBNP, creatine kinase isoenzyme (CK-MB), troponin T (TnT), LVEF, and left ventricular end-diastolic diameter (LVEDD) were measured in subjects with predicted cardiovascular events The areas under the curve were 0.756, 0.525, 0.536, 0.694 and 0.519, respectively. Only NT-proBNP and LVEF had predictive value. The positive predictive value for NT-proBNP at 762 fmol / mL for cardiovascular events was 42.7%, the negative predictive value was 88.0%, the sensitivity was 75.9%, the specificity was 63.3%, and the accuracy was 66.7%. Total cardiovascular events (42.7%), heart failure (41.7%), cardiogenic shock (10.4%) and case fatality rate (6.3%) were significantly higher in NT-proBNP> 762fmol / 12.0%, 12.0%, 2.8% and 0.9% of NT-proBNP≤762fmol / mL group (108 cases) (P <0.05). Univariate analysis showed that age, women, diabetes, smoking, LVEF and NT-proBNP were associated with prognosis. Multiple regression analysis showed that NT-proBNP, age, diabetes and LVEF were independent predictors of recent cardiovascular events. Conclusion NT-proBNP can predict the short-term prognosis of patients with acute ST-segment elevation myocardial infarction.