监测氮基末端脑钠肽前体对急性冠脉综合征患者的临床意义  

The Clinical suggestion of detecting N terminal pro-brain natriuretic peptide for acute coronary syndromes patient

作　　者：陈阵[1] 刘韬[1] 许懋[1] 刘亚凤[1] 胡念丹[1] 苏薇薇[1] 李文强[1] 

机构地区：[1]武汉大学人民医院急诊科,湖北省430060

出　　处：《中国急救复苏与灾害医学杂志》2012年第8期721-725,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨急诊监测氮基末端脑钠肽前体（NT—pmBNP）对于急性冠脉综合征（AcuteCoronarySyndrome，ACS）患者的危险性判断及预后评估的临床意义。方法选取本院2010年间因ACS入住急诊科患者的临床资料，并进行电话随访。根据患者预后分为存活组和死亡组，通过组间单因素比较及多因素Logistic回归分析等方法评价各因素与ACS患者死亡的相关性。结果共调查100例患者，其中ST抬高型心肌梗死患者41例，非AT抬高型心肌梗死患者25例，不稳定型心绞痛患者44例。平均年龄（61．62±10．45）岁，男性61例（61％），存活组和死亡组分别为83（83％）例和17（17％）例。与存活组相比，年龄、性别、高血压史、NT-proBNP、TnIUItra有统计学意义。经Logistic回归分析结果显示年龄（On=1．03，95％CI：1．02-1．05，P〈0．01）、性别即男性所占比例（OR=1．04，95％CI：I．01-1．06，P〈0．01）、高血压史（OR=I．05，95％CI：1．03-1．08，P〈O．01）、NT-proBNP（OR=1．17，95％CI：1．12-1．24，P〈0．01）、TnIUItra（OR=1.11，95％CI：1．07-1．14，P〈0．01）与ACS患者死亡有显著相关性。通过ROC曲线检验NT-proBNP的预测效能，计算ROC曲线下面积为0．805（P〈0．01，95％CI：0．798-0．812）。结论NT-proBNP升高将显著增加ACS患者死亡风险，可作为ACS患者死亡的独立预测因素。Objective To evaluate the clinical meanings of the risk judgment and prognosis of emergency detecting N terminal pro-brain natriuretic peptide （NT-proBNP） for acute coronary syndromes （ACS） patients. Methods Based on the ACS data collected from the hospital for the year of 2010, two groups were created with the prognosis results by phone interviews, survival group and death group. Univariate comparison was made between the two groups, as well as multivariate logistic regression analysis and other methods to evaluate the factors associated with mortality of patients with ACS. Results Out of the 100 cases investigated, there are 41 cases of ST-segment elevated myocardial infarction （STEMI）, 25 non-ST-segment elevated myocardial infarction （NSTEMI）, and 44 unstable angina. The patient＇s average age is （61.62 ± 10.45） years old, with 61% male versus 39% female and a surviva rate of 83%. Comparing with survival group, the age, gender, history of hypertension, NT-proBNP, TnlUItra of death group are statistically significant. The Logistic regression analysis demonstrates the following factors correlate with the death of the second group, age （OR=1.03, 95% CI：1.02-1.05, P〈0.01）, the proportion of male （OR=1.04, 95% CI： 1.01 -1.06, P〈0.01）, high blood pressure history （OR=1.05, 95% CI： 1.03-1.08, P〈0.01）, NT-proBNP （OR=1.17, 95% CI： 1.12-1.24, P〈0.01）, TnlUItra （OR=1.11, 95% CI ： 1.07-1 .14, P〈0.01）. By ROC curve test NT-proBNP forecasts performance computing area under the ROC curve 0.805 （P〈0.01, 95% CI： 0.798-0.812）. Conclusion NT-proBNP significantly increases the risk of death in patients with ACS, which may be measured as independent predictors of the death.

关 键 词：急性冠脉综合征 氮基末端脑钠肽前体 急诊 预后 

分 类 号：R459.7[医药卫生—急诊医学]