直接PCI患者LVEF与BNP的相关性及其预后预测价值的临床研究  

The correlation between BNP and LVEF and their predictive value on prognosis in patients received emergency PCI

作　　者：张鸿举[1] 刘孝钧[1] 尚咏琦[1] 梁毅[1] 丁少娟 王相智[1] 吴慧敏[1] 李文[1] 李莉[1] 叶兴[1] 

机构地区：[1]徐州市第一人民医院心内科,221002

出　　处：《中国实用医药》2012年第34期14-16,共3页China Practical Medicine

摘　　要：目的研究直接PCI患者左室射血分数(LVEF)与脑型钠尿肽(BNP)之间的相关性,分析LVEF与血BNP对于直接PCI患者预后的预测作用。方法 57例连续选入的接受直接PCI植入支架的急性心肌梗死患者,分别于入院后24h内、1周、2周、1月和6月进行血BNP检测及超声心动图测定LVEF。所有患者随访1年,记录主要不良心脏事件(MACE)发生情况,分析MACE与BNP以及LVEF之间的相关性。结果患者入院后24h内、1周、2周、1月和6月的血BNP与LVEF均呈显著负相关,相关系数r分别为-0.896(P=0.000)、-0.891(P=0.000)、-0.887(P=0.000)、-0.871(P=0.000)和-0.876(P=0.000)。随访1年,共发生MACE36例,MACE与入院后24h(r=0.742,P=0.000)、1周(r=0.719,P=0.000)的血BNP水平呈显著正相关;MACE与入院后24h(r=-0.813,P=0.000)、1周(r=-0.762,P=0.000)、2周(r=-0.867,P=0.000)的LVEF呈显著负相关。多元logistic回归分析显示,入院1周的BNP值以及入院24h的LVEF是MACE的独立预测因子。入院1周BNP的ROC曲线下面积0.812(P=0.000),其面积95%可信区间为[0.729,0.893],不包括0.5;入院1周LVEF的ROC曲线下面积0.822(P=0.000),其面积95%可信区间为[0.764,0.923],也不包括0.5;入院1周的BNP值以及入院1周的LVEF的拐点分别为226.36ng/L和48%。结论对于接受直接PCI植入支架的急性心肌梗死患者,BNP与LVEF预后有密切的关系,尤其是入院1周的BNP值以及入院24h的LVEF可有效预测入院后1年内的MACE事件发生情况。Objective To investigate the correlation between BNP and LVEF, and to evaluate their predictive value on prognosis in patients received emergency PCI. Methods 57 consecutive patients underwent primary PCI were selected for determining BNP level and LVEF at 24 hours, 1 week, 2 weeks, 1 month and 6 months after the stent implantation. All cases were followed up for 1 year to record major adverse clinical events（MACE）. Then the correlations of BNP and LVEF to MACE were analyzed. Results BNP level and LVEF at 24 hours, 1 week, 2 weeks, 1 month and 6 months after the stent implantation were negatively correlated respectively, of which correlation coefficient were -0.896（P=0.000）, -0.891（P=0.000）, -0.887（P=0.000）, -0.871（P=0.000） and -0.876（P=0.000） respectively. 36 MACEs occurred during the 1-year follow-up. MACE had a significantly positive correlation with BNP level of 24 hours（r=0.742, P=0.000） and 1week（r=0.719, P=0.000） after admission and a significantly negative correlation with LVEF of 24 hours（r=-0.813, P=0.000）, 1week（r=-0.762, P=0.000） and 2 weeks（r=-0.867, P=0.000） after admission. According to logistic regression analysis, BNP level of 1 week after admission and LVEF at 24 hours after admission were all independent predictors to MACE in patients underwent primary PCI during the first year after operation（P=0.001; P=0.000）.The area under curve （AUC） of the BNP level of 1 week after admission and LVEF at 24 hours after admission on ROC were 0.812（P=0.000） and 0.822 （P=0.000） respectively and 95% confidence interval were[0.729, 0.893] and [0.764, 0.923], respectively. According to ROC, inflection point of the BNP level of 1 week after admission and LVEF at 24 hours after admission were 226.36ng/L and 48%, respectively.Conclusion For patients received primary PCI, BNP level and LVEF are significantly correlated with their prognosis and especially, BNP level of 1 week after admission and LVEF at 24 hours after admission are effective in predicting MAC

关 键 词：直接PCI 脑型钠尿肽 左室射血分数 预后 

分 类 号：R542.22[医药卫生—心血管疾病]