胱抑素C和N末端B型利钠肽原评估非ST段抬高型急性冠脉综合征预后的价值  

Prognostic value of cystatin C and NT-proBNP in patients with non-ST elevation acute coronary syndrome

作　　者：徐海燕[1] 陈雨[1] 蒙涛[1] 马树人[1] 谢雄伟[1] 

机构地区：[1]南京医科大学附属淮安第一医院心内科,江苏淮安223300

出　　处：《心血管康复医学杂志》2016年第1期88-93,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的：探讨胱抑素C（CysC）联合N末端B型利钠肽原（NT-proBNP）评估非ST段抬高型急性冠脉综合征（NSTE-ACS）患者预后的价值。方法：选择2012年1月至2012年12月在我院住院的166例NSTE-ACS患者。出院后随访12个月,记录测定所有患者一般资料,CysC、NT-proBNP、高敏C反应蛋白（hsCRP）、心肌肌钙蛋白I（cTnI）水平等指标情况以及主要不良心血管事件（MACE）发生率。根据随访期间是否发生MACE,156例患者被分为无MACE组（137例）和MACE组（19例）,分析NSTE-ACS患者发生MACE的危险因素,进行受试者工作特征曲线（ROC）分析,并分析相关指标预测NSTE-ACS患者发生MACE的最佳界值。结果：与无MACE组比较,MACE组年龄[（60.26±10.45）岁比（64.16±11.21）岁]明显较大,CysC[（1.02±0.11）mg/L比（1.15±0.12）mg/L]、NT-proBNP[（251.97±89.65）pg/ml比（347.93±107.29）pg/ml]、hsCRP[（14.69±3.53）mg/L比（17.13±3.68）mg/L]和cTnI[（0.36±0.46）ng/ml比（0.90±0.88）ng/ml]水平显著升高,P〈0.05或〈0.01。多因素回归分析显示CysC、NT-proBNP和cTnI水平是NSTE-ACS患者发生MACE的独立预测因子（P〈0.05或〈0.01）。绘制CysC,NT-proBNP,cTnI和hsCRP判定预后的ROC曲线,仅CysC和NT-proBNP的曲线下面积（AUC）〉0.7[CysC：0.784,95%CI：0.687～0.881;NT-proBNP：0.753,95%CI：0.639～0.867];并得出CysC=1.07mg/L和NT-proBNP=279.60pg/ml是预测MACE的最佳界值,以此作为危险分层界值绘制Kaplan-Meier生存曲线,显示高危组生存时间显著短于低危组（P〈0.05）。结论：血清CysC、NTproBNP水平是评估非ST段抬高型急性冠脉综合征患者预后的独立预测因子。Objective： To explore the prognostic value of CysC and NT-proBNP in patients with non-ST elevation a- cute coronary syndrome （NSTE-ACS）. Methods： A total of 166 NSTE-ACS patients hospitalized in our hospital from Jan 2012 to Dec 2012 were selected. They were followed up for 12 months, then general data, levels of CysC, NT-proBNP, hsCRP and cTnI etc. and incidence rate of MACE were recorded and measured. According to MACE occurrence during follow-up or not, 156 cases were divided into non- MACE group （n = 137） and MACE group （n = 19）, risk factors for MACE in NSTE-ACS patients were analyzed, receiver operator characteristic curve （ROC） was performed, and the optimal cutoffs of related indexes predicting MACE occurrence in these patients were analyzed. Results： Compared with non-MACE group, there were significant rise in age [ （60.26±10.45） years vs. （64.16±11.21） years], levels of CysC [ （1.02±0.11） mg/L vs. （1.15±0.12） mg/L], NT-proBNP F （251.97±89.65） pg/ mlvs. （347.93±107.29） pg/ml], hsCRP[ （14. 69±3.53） mg/Lvs. （17.13±3.68） mg/L] andcTnI F （0.36±0.46） ng/ml vs. （0.90±0.88） ng/ml] in MACE group, P〈0.05 or〈0.01. Multi-factor regression analysis indica- ted that CysC, NT-proBNP and cTnI levels were independent predictors for MACE in NSTE-ACS patients （P〈0.05 or 〈0.01）. ROC curves of CysC, NT-proBNP, cTnI and hsCRP judging prognosis were drawn, only AUC of CysC and NT-proBNP curves were 〉0.7 [CysC： 0. 784, 95%CI： 0. 687～0. 881; NT-proBNP： 0. 753, 95%CI： 0. 639～0. 867], and it＇s analysis indicated that CysC -- 1.07 mg/L and NT-proBNP = 279.60 pg/ml were their optimal cutoffpredicting MACE. Kaplan-Meier survival curves with above two cutoffs as risk stratification cutoff indicated that survival time of high risk group was significantly shorter than that of low risk group （P〈0.05）. Conclusion： Serum CysC and NT-proBNP levels are independent predictors assessing prognosis in NSTE-ACS patients.

关 键 词：急性冠状动脉综合征 半胱氨酸蛋白酶抑制物C 利钠肽 脑 预后 

分 类 号：R541.409[医药卫生—心血管疾病]