非ST段抬高急性冠状动脉综合征患者血浆N末端B型利钠肽原与GRACE评分的相关研究  

Relationship between plasma N-terminal pro-brain natriuretic peptide and GRACE risk stratification in non-ST-segment elevation acute coronary syndrome

作　　者：刘文娴[1] 赵晗[1] 

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

出　　处：《中华心血管病杂志》2012年第5期373-377,共5页Chinese Journal of Cardiology

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B型利钠肽原（NT—proBNP）的水平与全球急性冠状动脉事件注册（GRACE）评分及危险分层的关系，分析NT—proBNP对NSTE．ACS患者近期（6个月）发生主要不良心脏事件（MACE）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，其中不稳定性心绞痛（uA）161例，非ST段抬高心肌梗死（NSTEMI）70例。入院后测定血浆NT—proBNP浓度。采用GRACE评分标准计算患者GRACE积分并进行危险分层，低危组62例，中危组78例，高危组91例。住院期间进行常规治疗。患者出院后随访6个月，观察终点为发生MACE的情况。结果将NSTE—ACS患者作GRACE危险分层，高危组lgNT-proBNP高于中危组和低危组（P均〈0．001）．中危组lgNT—proBNP高于低危组（P=0．048）。NT—proBNP按照四分位数分成Q1～Q4组，Q4组GRACE分值分别高于其他3个四分位数组（P〈0．001），Q4组中GRACE高危百分比高于Q4以下组（P〈0．001）。NSTE—ACS患者的lgNT—proBNP与其GRACE分值呈正相关（r=0．59，P〈0．001）。随访观察中，231例患者中发生MACE者9例，占3．9％。使用受试者工作曲线（ROC）分析基线NT—proBNP对NSTE-ACS患者6个月内发生MACE的曲线下面积（AUC）为0．831（SE=0．062，P=0．001，95％C10．711～0．952）。ROC分析基线GRACE评分对NSTE—ACS患者6个月内发生MACE的AUC为0．799（SE=0．079，P=0．002，95％C10．644～0．954）。两项指标在预0n,0NSTE—ACS患者近期（6个月内）发生MACE的价值上的差异无统计学意义。结论NSTE—ACS患者NT-proBNP水平越高，GRACE积分越高，NT—proBNP的检测在对NSTE—ACS患者进行早期、快速的危险度分层方面有着独特的价值。基线NT—proBNP明显升高的NSTE—ACS患者，其在随访期发生MACE的危险度增加，NT—proBNP是NSTE—ACS患者近期发生MACEObjective To explore the relationship between plasma N-terminal pro-brain natriuretic peptide（NT-proBNP） level obtained on admission and global registry of acute coronary events （GRACE） scores and the value for risk stratification in patients with non-ST-segment elevation acute coronary syndrome （NSTE-ACS）. Methods A total of 231 NSTE-ACS patients admitted in our hospital between June 2009 and September 2010 were included E 161 patients with unstable angina （UA） and 70 patients with non-ST- segment elevation myocardial infarction （NSTEMI） 1. On admission plasma NT-proBNP was measured in all patients. The GRACE risk score were used for risk assessment. Patients were followed up for 6 months and incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure （ MACE ） was recorded. Results According to GRACE risk stratification, there were 62 low-risk patients, 78 middle-risk patients and 91 high-risk patients, lgNT-proBNP level on admission increased in proportion to increasing risk defined by GRACE risk stratification and lgNT-proBNP positively correlated with GRACE risk score （r = 0. 59, P 〈 0. 001 ）. The GRACE risk score was the highest in the fourth NT-proBNP quartile （P 〈 0. 001 vs. lowest, second and third quartiles）. GRACE score was significantly higher in patients with NT-proBNP level above the 75 percentile compared patients with NT-proBNP under the 75 percentile （P 〈0. 001 ）. MACE occurred in 9 [3.9% （9/231） ] patients during follow up. ROC analysis showed AUC of on admission NT-proBNP was 0. 831 （SE =0. 062,P =0. 001, 95% CI O. 711 -0. 952） and AUC of GRACE risk score was 0. 799（SE =0. 079,P =0. 002, 95% C1 0. 644 -0. 954） for predicting the short-term risk of MACE （P = 0. 75 ）. Conclusion On admission plasma NT-proBNP level parallels GRACE risk score in NSTE-ACS patients, both on admission plasma NT-proBNP level and GRACE risk score are valuable parameters for risk stratification in patients with

关 键 词：冠状动脉疾病 利钠肽 脑 危险性评估 预后 

分 类 号：R541.4[医药卫生—心血管疾病]