非ST段抬高型急性冠脉综合征患者脑钠尿肽与GRACE危险评分的相关性及其预测价值  

Relationship between brain natriuretic peptide and global registry of acute coronary events in non-ST-segment elevated acute coronary syndrome

作　　者：朱荔[1] 陈韬[1] 陈亮[1] 汪莹[1] 李文文[1] 余慧[1] 赵仙先[1] 

机构地区：[1]第二军医大学附属长海医院心血管内科,上海200433

出　　处：《心脏杂志》2015年第1期41-44,共4页Chinese Heart Journal

摘　　要：目的： 探讨非ST段抬高型急性冠状动脉综合征（non-ST-segment elevated acute coronary syndrome，NSTE-ACS）患者血浆脑钠尿肽（brain natriuretic peptide，BNP）的水平与全球急性冠状动脉事件注册（global registry of acute coronary events，GRACE）评分及危险分层的关系，分析BNP对NSTE-ACS患者近期（6个月）发生主要不良心脏事件（major adverse cardiac event，MACE）的预测价值。方法： 入选2011年12月-2013年2月在我院心内科住院的NSTE-ACS患者194例，其中不稳定型心绞痛（unstable angina，UA）90例，急性非ST段抬高型心肌梗死（non-ST segment elevated myocardial infraction，NSTEMI）104例。入院后测定BNP及血脂水平。采用GRACE危险评分标准计算患者GRACE评分并进行危险分层，低危组59例，中危组65例，高危组75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患者按GRACE评分进行危险分层，高危组BNP高于中危组和低危组（均P〈0.01），中危组BNP显著高于低危组（P〈0.01）。血浆BNP水平与GRACE评分呈正相关（r=0.656，P〈0.05）。随着GRACE评分越高，血浆BNP水平亦增高，住院期间、随访期MACE发生率也随之增高。结论： GRACE评分越高，BNP水平越高，在NSTE-ACS患者中，联合运用GRACE评分和BNP水平检测，在对其进行早期危险分层、评估预后方面有重要临床价值。AIM： To study the relationship between the global registry of acute coronary events （GRACE） risk score and level of brain natriuretic peptide （BNP） and to evaluate the value of BNP in predicting major adverse cardiac event （MACE）. METHODS： A total of 194 non-ST-segment elevated acute coronary syndrome （NSTE-ACS） patients admitted to our hospital between December 2011 and February 2013 were studied, including 90 patients with unstable angina （UA） and 104 patients with non-ST segment elevated myocardial infarction （NSTEMI）. Plasma levels of BNP and blood lipid were measured in all patients and GRACE risk scores were used for risk assessment. Patients were followed-up for 6 months and the incidences of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, and heart failure were recorded. RESULTS： According to the GRACE risk score, 59 were low-risk patients, 65 middle-risk patients and 70 high-risk patients. Plasma BNP of patients in the high-risk group was significantly higher than in the middle- and low-risk groups （ P 〈 0. 05 ）. In addition, BNP was positively correlated with the GRACE risk score （ r = 0. 656, P 〈 0. 05 ）. Along with the higher GRACE risk score, plasma BNP increased as well as the incidence of MACE during hospitalization or the 6-month follow-up. CONCLUSION： Plasma BNP level parallels the GRACE risk score. Both the GRACE risk score and the plasma BNP level are valuable parameters for risk stratification in NSTE-ACS patients in early stages. Increased BNP level and higher GRACE score are also predictors for increased short-term risk of MACE.

关 键 词：冠状动脉综合征 急性 非ST段抬高型 脑钠尿肽 全球急性冠状动脉事件注册评分 预后 

分 类 号：R541.4[医药卫生—心血管疾病]