急性冠状动脉综合征患者血浆NT-proBNP水平与冠状动脉病变严重程度的关系  

Relationship between N-terminal pro-brain natriuretic peptide and severity of the coronary lesions in non-ST-segment elevation acute coronary syndrome

作　　者：赵晗[1] 刘文娴[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,北京100029

出　　处：《心肺血管病杂志》2011年第6期506-510,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者,血浆N-末端脑钠肽前体(NT-proBNP)与冠状动脉病变严重程度的关系,以及对冠状动脉3支血管病变的预测价值。方法:入选2009年6月至2010年9月,在我院心内科住院的NSTE-ACS患者231例。入院后测定血浆NT-proBNP浓度,行冠状动脉造影检查并计算冠状动脉病变Gensini积分。分析NSTE-ACS患者血浆NT-proBNP浓度与Gensini积分的关系,与冠状动脉病变部位、病变支数的关系,以及对冠状动脉3支血管病变的预测价值。结果:NSTE-ACS患者冠状动脉3支病变组,LgNT-proBNP分别高于双支病变组(P<0.001)及单支病变组(P<0.001),双支病变组LgNT-proBNP高于单支病变组(P=0.021)。NT-proBNP按照中位数分组后,P50以上组LgGensini明显高于P50以下组(P<0.001)。NSTE-ACS患者的LgNT-proBNP与LgGensini呈正相关关系(r=0.55,P<0.001)。NSTE-ACS患者冠状动脉病变累及前降支(LAD)组的LgNT-proBNP高于未累及LAD组(P<0.001)。Logistic回归分析发现,随着NT-proBNP四分位数层级的升高,冠状动脉3支病变相应的比值比(OR)值逐渐增大,与最低层级相比,最高层级和第3个层级的OR值分别为13.54(P<0.001),95%CI(5.33,34.40)和6.70(P<0.001),95%CI(2.70,16.58)。使用受试者工作曲线(ROC)分析NT-proBNP,预测NSTE-ACS患者冠状动脉3支病变的曲线下面积(AUC)为0.765,P<0.001,95%CI(0.701,0.828)。结论:NSTE-ACS患者NT-proBNP水平越高,冠状动脉病变越严重;LAD病变者的NT-proBNP明显升高,高于未累及LAD者;NT-proBNP可作为预测NSTE-ACS患者冠状动脉3支血管病变的一个有效指标。Objective：To find out the relationship between NT-proBNP levels and severity of the coronary lesions in patients with non-ST-segment elevation acute coronary syndrome（NSTE-ACS） and the predictive value of NT-proBNP for 3-vessel lesions.Methods： 231 patients with NSTE-ACS were enrolled from June 2009 to September 2010.All of the patients received plasma NT-proBNP measurement and angiographic examination.To evaluate the relationship between NT-proBNP level and severity of the coronary lesions and the predictive value of NT-proBNP level for 3-vessel lesions.Results： The NT-proBNP level of 3-vessel lesion group was higher than 2-vessel lesion group（P〈0.001） and 1-vessel lesion group（P〈0.001）,NT-proBNP level of 2-vessel lesion group was higher than 1-vessel lesion group（P=0.021）;After stratifying patients into two groups by median of NT-proBNP,patients with NT-proBNP level above the 50 percentile had higher LgGensini than patients with NT-proBNP under the 50 percentile（P〈0.001）.The LgNT-proBNP of NSTE-ACS patients had positive correlation with LgGensini（r=0.55,P〈0.001）.The LgNT-proBNP of LAD lesion group was higher than non-LAD lesion group（P〈0.001）.By Logistic regression analysis,NT-proBNP level was correlated to the risk of 3-vessel lesions,increased odds ratio（OR） was associated with increased NT-proBNP quartiles.Compared to the lowest quartiles,the OR of 3-vessel lesions in the third and fourth quartiles were 6.70（P〈0.001）,95%CI（2.70,16.58） and 13.54（P〈0.001）,95%CI（5.33,34.40）.ROC curve analysis showed NT-proBNP was valuable for the prediction of 3-vessel lesions in NSTE-ACS patients,AUC 0.765,P〈0.001,95%CI（0.701,0.828）.Conclusion： In NSTE-ACS patient,increased NT-proBNP level was associated with deteriorated coronary artery stenosis;NT-proBNP level of LAD lesion increased significantly.The NT-proBNP level can be a predictive factor for 3-vessel lesions in NSTE-ACS.

关 键 词：脑钠肽 急性冠状动脉综合征 GENSINI积分 

分 类 号：R541.4[医药卫生—心血管疾病]