血浆脑钠尿肽前体水平联合TIMI评分对STEMI患者的预后评估价值  

Prognostic Value of N-pro-B-type Natriuretic Peptide Combined with TIMI Risk Score for ST Segment Elevation Myocardial Infarction

作　　者：李雪梅[1] 

机构地区：[1]山西医科大学

出　　处：《中西医结合心脑血管病杂志》2014年第7期807-809,共3页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的：探讨血浆脑钠尿肽前体（NT proBNP）联合心肌梗死溶栓（TIMI）危险评分对ST段抬高性急性心肌梗死（STEMI）患者住院期间及3个月随访期主要心血管事件（MACE ）发生率的预测价值。方法回顾性分析304例STEMI患者入院时血NT proBNP水平及TIMI危险评分。通过绘制受试者工作特征曲线（ROC）及应用Logistic回归分析,确定 NT proBNP 在评分中的分值及其最佳界值,建立 NT proBNP联合TIMI危险评分的新评分系统,比较其与常规TIMI评分对STEMI患者住院期及3个月随访期 MACE发生率预测价值。结果通过 ROC曲线下面积（AUC）分析发现,NTproBNP 的 AUC 为0.732（95%CI 0.670-0.794,P〈0.01）；预测MACE发生率的最佳界值为741。TIMI危险评分的AUC为0.792（95%CI0.735-0.848,P〈0.01）。NT proBNP联合TIMI危险评分的新评分系统的 AUC为0.836（95%CI 0.786-0.885,P〈0.01）,经配对比较,二者比较差异有统计学意义（Z=15.977,P〈0.01）。结论入院时 NTproBNP可以增强TIMI危险评分对 STEMI患者住院期及随访期 MACE发生率的预测价值。Objective To investigate the predicting value of major adverse cardiovascular events （MACE）with scoring system of thrombolysis in myocardial infarction （TIMI）risk score and N terminal pro B type natriuretic peptide （NT proBNP）in ST segment elevation myocardial infarction （STEMI）.Methods The serum level of NT proBNP and TIMI risk score in 304 STEMI patients were measured in a retrospective study.The receiver operating characteristic curve （ROC）and Logistic regression analysis were used to evaluate prognostic contribution of NT proBNP and TIMI risk score,and propose an optimal cut off of NT proBNP.TI-MI risk score modified by NT proBNP was created.The accuracy of this new score was compared with the usual TIMI risk score by comparing the area under the curve （AUC）of the 2 scores.Results The results by ROC showed that：NT proBNP （AUC 0.732, 95%CI 0.670 to 0.794,P〈0.01）,predictive optimal cutoff of the incidence of MACE was 741ug/L.TIMI risk score was AUC 0. 792（95%CI 0.735 to 0.848,P〈0.01）.Addition of NT proBNP to the TIMI risk score could improve its prognostic value （AUC 0.836,95%CI 0.786 to 0.885,P〈0.01）,the difference was statistically significant by paired t test（Z=15.977,P〈0.01）.Conclusion NT proBNP could add the prognostic value of TIMI risk score for MACE rate of STEMI patients both hospitalization and follow up.

关 键 词：ST段抬高性急性心肌梗死 脑钠尿肽前体 TIMI危险评分 预后 

分 类 号：R542.22[医药卫生—心血管疾病]