NT-pro-BNP改良的GRACE风险评分对ACS患者12个月心血管事件的预测价值  

Prognostic value of NT-pro-BNP-modified GRACE risk score for cardiovascular events in patients with acute coronary syndrome

作　　者：赖国华[1] 兰军[1] 涂昌[1] 刘瑞杰[1] 蔡振明[1] 

机构地区：[1]南方医科大学附属东莞石龙人民医院心血管内科,东莞523326

出　　处：《山西医科大学学报》2015年第7期641-644,共4页Journal of Shanxi Medical University

摘　　要：目的 探讨NT-pro-BNP改良的GRACE风险评分对急性冠脉综合征（ACS）患者心血管事件的预测价值。方法 回顾分析南方医科大学附属东莞石龙人民医院2010-06～2012-06间400例ACS患者入院时NT-pro-BNP水平和GRACE风险评分。通过绘制ROC曲线分析NT-pro-BNP对心血管事件的预测价值和最佳界值,并根据Logistic回归分析结果的OR值,确定NT-pro-BNP在评分中的分值,建立NT-pro-BNP改良的GRACE风险评分。通过比较曲线下面积（AUC）来比较改良的GRACE风险评分和常规的GRACE风险评分对心血管事件的预测价值。结果 12个月内的心血管事件的发生率是33.5%。NT-pro-BNP对12个月内的心血管事件有良好的预测价值,曲线下面积（AUC）为0.715（95%CI,0.731-0.880,P=0.000）,其最佳界值为1 348.0 ng/ml,而且在Logistic回归分析中经GRACE风险积分校正后仍保留其预测价值。GRACE风险评分预测12个月心血管事件的AUC为0.623（95%CI 0.545-0.701）,增加NT-pro-BNP参数后,增强了GRACE风险评分对12个月心血管事件预测价值（AUC 0.761,95%CI 0.694-0.992）,GRACE风险评分和NT-pro-BNP改良的GRACE风险评分预测心血管事件的AUC二者比较,差异有统计学意义（Z=2.62,P=0.02）。结论 NT-pro-BNP改良的GRACE风险评分对急性冠脉综合征（ACS）患者心血管事件有更好的预测价值。Objective To explore if NT-pro-BNP could enhance the relevant prognostic value of GRACE-risk score for cardiovascular events in patients with acute coronary syndrome（ACS）. Methods A total of 400 hospitalized ACS patients with complete clinical in- formation from January 2011 to June 2012 were enrolled and their GRACE risk scores and NT-pro-BNP levels were reviewed. The ROC curve was used to evaluate the prognostic value of NT-pro-BNP in cardiovascular events and propose the cut-off of NT-pro-BNP level. NT-pro-BNP score was determined in the GRACE risk score by OR based on Logistic regression analysis. Then a NT-pro-BNP-modified GRACE risk score was established. The accuracy of this new score was compared with the usual GRACE-risk score by the AUC. Re- sults The incidence of cardiovascular events was 33.5% within 12 months. A significant predictive value of NT-pro-BNP for cardio- vascular events within 12 months was indicated by AUC （ AUC = 0. 716,95 % CI 0.731 - 0. 980,P = 0. 000）, the cut-off of NT-pro-BNP level was 1 348.0 ng/ml. Logistic regression analysis showed that NT-pro-BNP remained a significant predictor of the cardiovascular e- vents after adjustment by GRACE-risk score. The AUC for the GRACE risk score was 0. 623 （95% CI 0. 545 -0. 701 ）. The addition of NT-pro-BNP to the GRACE risk score improved its prognostic value （ AUC = 0. 761,95 % CI 0. 694 - 1. 392 ） , and there was significant difference between the new score and the usual GRACE risk score （ Z = 2.62, P = 0.02 ）. Conclusion NT-pro-BNP could enhance the prognostic value of the GRACE risk score for cardiovascular events in patients with ACS.

关 键 词：急性冠脉综合征 预后 氨基末端脑钠肽前体 GRACE风险评分 

分 类 号：R541.4[医药卫生—心血管疾病]