急性胸痛评分及血清B型脑钠肽对急诊胸痛患者心血管不良事件的预测价值  

Value of acute chest pain risk stratification and serum brain natriuretic peptide to predicting major acute cardiac event in patients with acute chest pain

作　　者：高云[1] 阴赪茜[1] 孙涛[1] 李志忠[1] 张京梅[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中华实用诊断与治疗杂志》2015年第1期37-40,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：教育部新教师基金(20111107120015)

摘　　要：目的探讨全球急性冠状动脉事件注册（Global Registry of Acute Coronary Events,GRACE）评分、心肌梗死溶栓疗法（the Thrombolysis in Myocardial Infarction,TIMI）危险评分及血清B型脑钠肽（B-type natriuretic peptide,BNP）对急诊胸痛患者心血管不良事件的预测价值。方法回顾性分析536例急性胸痛患者的临床资料,计算患者基线水平GRACE、TIMI评分,检测血清BNP并进行30d随访。应用单因素分析和logistic回归确定急性胸痛患者急诊入院、30d死亡、急诊经皮冠状动脉介入术及其他心血管不良预后的独立预测因素;计算GRACE评分、TIMI评分及血清BNP预测相关不良心血管事件ROC曲线下面积。结果 536例患者年龄（55.7±12.7）岁,急诊入院319例（59.5%）,30d死亡45例（8.4%）;与TIMI评分和血清BNP比较,GRACE评分可独立预测患者急诊入院（OR：1.02,95%CI：1.010～1.030,P=0.010）、30d死亡（OR：1.05,95%CI：1.040～1.070,P=0.001）和急诊经皮冠状动脉介入术（OR：1.02,95%CI：1.010～1.030,P=0.000）的风险;GRACE评分的急诊入院（AUC：0.873,95%CI：0.843～0.903）、30d死亡（AUC：0.654,95%CI：0.573-0.736）、急诊经皮冠状动脉介入术（AUC：0.746,95%CI：0.705～0.787）及其他心血管不良预后（AUC：0.651,95%CI：0.577～0.725）的ROC预测曲线均有统计学意义（P〈0.01）。结论与TIMI评分和血清BNP相比,GRACE评分可更有效判断急性胸痛患者急诊入院、30d死亡、急诊经皮冠状动脉介入术及其他心血管不良预后的风险。Objective To explore the value of Global Registry of Acute Coronary Events（GRACE）score,the Thrombolysis in Myocardial Infarction（TIMI）risk score and serum B-type natriuretic peptide（BNP）detection to predicting the major acute cardiac events（MACE）in patients with acute chest pain.Methods The clinical data of 536 patients with acute chest pain were retrospectively analyzed to calculate the GRACE and TIMI risk scores,and the serum BNP levels were detected.All patients were followed up for 30 days.Univariate analysis and logistic regression were used to determine the independent risk factors as emergent admission,30-day death,percutaneous coronary intervention（PCI）rate and the prognosis of other MACE.The AUCs of GRACE score,TIMI score and serum BNP for MACE were analyzed.Results The average age of the patients was（55.7±12.7）years,319patients（59.5%）were emergently admitted,and 45patients（8.4%）died in 30 days after admission.GRACE score was an independent predictor for emergent admission（OR：1.02,95%CI：1.010 to 1.030,P=0.010）,30-day death（OR：1.05,95%CI：1.040to1.070,P=0.001）and PCI（OR：1.02,95%CI：1.010 to 1.030,P=0.000）in comparison with TIMI score and serum BNP.There were significant differences in AUCof GRACE score for emergent admission（AUC：0.873,95%CI：0.843 to 0.903）,30-day death（AUC：0.654,95%CI：0.573 to 0.736）,PCI（AUC：0.746,95%CI：0.705 to 0.787）and the prognosis of other MACE（AUC：0.651,95%CI：0.577 to 0.725）（P〈0.01）.Conclusion GRACE score can more effectively predict the risk for emergent admission,30-day death,PCI and other MACE than TIMI risk score and serum BNP.

关 键 词：急性胸痛 全球急性冠状动脉事件注册评分 心肌梗死溶栓疗法危险评分 血清B型脑钠肽 死亡 心血管事件 预后 

分 类 号：R54[医药卫生—心血管疾病]