B型尿钠肽水平对急性心肌梗死患者心源性死亡的预测价值  

The predictive value of B-type natriuretic peptide for the mortality from acute myocardial infarction

作　　者：杨跃进[1] 毛懿[1] 倪新海[1] 陈纪林[1] 高润霖[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 阜外心血管病医院 冠心病诊治中心,北京100037

出　　处：《中华内科杂志》2007年第6期450-453,共4页Chinese Journal of Internal Medicine

基　　金：首都发展基金(2002-1029)

摘　　要：目的探讨急性心肌梗死(AMI)患者血 B 型尿钠肽(BNP)水平预测死亡的价值。方法对264例 AMI 患者随访(14.7±5.3)个月,随访率为87.1%。检测肌酸激酶同工酶(CK-MB)、肌钙蛋白(TnT)、左室舒张末径、左室射血分数和 BNP,并绘制受试者工作特性曲线(ROC)对比评价BNP 等指标对 AMI 后心源性死亡的预测价值。结果 ROC 曲线显示仅 BNP 能预测心源性死亡。据ROC 曲线定864ng/L 为最佳分界值时,预测 AMI 后1、6个月和1年时心源性死亡的敏感性、特异性、准确度、阳性和阴性预测值分别为76.2%～92.9%、84.3%～85.6%、82.2%～86.1%、21.3%～36.2%和97.3%～98.9%。多元回归分析显示 BNP 是预测 AMI 后近、远期心源性死亡的独立危险因素(P<0.01)。BNP≤864ng/L 组1年无心源性死亡生存率显著高于 BNP>864ng/L 组(97.3%比72.3%,P<0.001),死亡者中位生存时间在前者亦显著长于后者(16.0比10.7个月,P<0.01),且与急诊 PCI 和 ST 段抬高与否无关。结论与传统指标相比 BNP 水平能预测 AMI 患者心源性死亡,且预测作用最佳。Objective To explore the predictive value of B-type natriuretic peptide （BNP） for the mortality of acute myocardial infarction （AMI）. Methods Follow-up was made in 264 consecutive patients with AMI, with an average period of （14. 7 ± 5.3） months and follow-up rate of 87. 1% （230 cases）. Cardiac death was recorded in the lst,tth and 12th month after AMI. Among one to seven days after AMI, the MB isoenzyme of creatine kinase （ CK-MB ）, tropnin T （ TnT ）, echocardiographically measured left ventricular end-diastolic internal diameter（ LVEDd）, left ventricular ejection fraction （LVEF） and BNP were determined. The Receiver Operating Characteristic （ROC） were drawn to determine the predictive value for the cardiac death after AMI comparing BNP with the classical risk factors mentioned above. Analysis was made to define the relative independent risk factors of cardiac death and non-cardiac death survival rate after AMI. Results The ROC curves comparing CK-MB,TnT, LVEDd and LVEF with BNP and lnBNP showed that BNP was the only index for predicting cardiac death after AMI, the cut off point value of BNP determined according to ROC curve was 864 ng/L and the sensitivity, specificity, accuracy, positive and negative predictive values for predicting the cardiac death was 76.2% - 92. 9% ,84. 3% - 85.6% ,82.2% - 86. 1% ,21.3% - 36. 2% and 97.3% - 98.9% at the 1st 16th, 12th month after AMI respectively. Furthermore, BNP showed the only independent risk factor for predicting the cardiac death in the short and long term period after AMI （ P 〈 0. 01 ） by multiple factors cox regression analysis. The non-cardiac death survival rate in the group of BNP level ≤ 864 ng/L was significantly higher than that in the group of BNP 〉864 ng/L（97.3% vs 72. 3%, P 〈0. 001 ）, and the median survival time of the dead in the former group was also significantly longer than in the latter group（ 16.0 vs 10.7, P 〈0. 01 ）, no matter whether they were suffering from AMI with ST elevation or not,

关 键 词：心肌梗塞 利钠肽 脑 死亡率 

分 类 号：R542.22[医药卫生—心血管疾病]