GRACE评分联合脑钠肽、糖化血红蛋白对急性冠脉综合征患者经皮冠状动脉介入术后发生院内事件的预测价值  

Value of GRACE Score Combined with BNP and Glycosylated Hemoglobin in Predicting MACE Events in Patients with Acute Coronary Syndrome after PCI

作　　者：郭继东[1] 赵媛媛[1] 王喜萍[1] 刘丹[1] 杜铮 张莹 高立建[2] 袁晋青[2] 赵雪燕[2] GUO Jidong;ZHAO Yuanyuan;WANG Xiping;LIU Dan;DU Zheng;ZHANG Ying;GAO Lijian;YUAN Jinqing;ZHAO Xueyan(Department of Cardiology,Shihezi City People s Hospital,Shihezi 832000,Xinjiang,China;Department of Cardiology,State Key Laboratory of Cardiovascular Disease,Fiowai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]石河子市人民医院心血管内科,石河子市832000 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室心内科,北京市100037

出　　处：《中国分子心脏病学杂志》2022年第2期4540-4545,共6页Molecular Cardiology of China

基　　金：中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-052);兵团科技计划项目中青年领军人才(2020CB012);八师石河子市重点领域科技攻关项目(2019ZH09)。

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)评分联合脑钠肽(brain natriuretic peptide,BNP)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)预测急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后发生院内主要不良心血管事件(major adverse cardiovascular events,MACE)的价值。方法连续纳入石河子市人民医院2019年6月至2020年6月收治的急性冠脉综合征患者675例,选取行PCI治疗的患者319例进行分析。住院期间MACE包括心源性猝死、心源性休克、充血性心力衰竭、再发缺血性胸痛、恶性心律失常。根据住院期间有无发生MACE,分为无MACE组和MACE组。采用受试者操作特征曲线下面积(area under the curve,AUC)评估GRACE评分、BNP和HbA1C对住院期间发生MACE的预测价值。结果319例患者在住院期间共发生MACE 26人次(8.15%)。MACE组中既往心力衰竭病史者较多(P<0.05),且入院收缩压、舒张压明显低于无MACE组(P<0.05),心率、GRACE评分、BNP、HbA1c水平明显高于无MACE组(P<0.05)。经多因素Logistic分析,既往心力衰竭病史、GRACE评分、BNP、HbA1C是ACS患者PCI术后发生院内MACE的独立危险因素(P<0.05)。GRACE评分、BNP和HbA1C预测ACS患者PCI术后发生院内MACE的AUC分别为0.758、0.838和0.788;GRACE评分联合BNP、HbA1C时,AUC为0.876(Z=4.142,P<0.001)。结论GRACE评分联合BNP和HbA1c较传统单一的GRACE评分显著提高了对ACS患者行PCI术后发生院内MACE的预测价值,在临床中有助于医师更好地识别院内事件的高危患者。Objective To investigate the value of Global Registry of Acute Coronary Events(GRACE)score combined with brain natriuretic peptide(BNP)and glycosylated hemoglobin(HbA1c)in predicting major adverse cardiovascular events(MACE)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 675 patients with ACS were enrolled who admitted to Shihezi People’s Hospital from June 2019 to June 2020,and finally 319 patients who were treated with PCI were included in this research.MACE during hospitalization included sudden cardiac death,cardiogenic shock,congestive heart failure,recurrent ischemic chest pain,and malignant arrhythmia.According to the occurrence of MACE during hospitalization,the patients were divided into non-MACE group and MACE group.The area under the receiver operator characteristic curve was used to evaluate the predictive value of GRACE score,BNP and HbA1C in the occurrence of MACE during hospitalization.Results The incidence of MACE in 319 patients during hospitalization was 8.15%(26/319).There were more patients with previous heart failure in the MACE group than that in the non-MACE group(P<0.05).The systolic and diastolic blood pressures of the MACE group were significantly lower than those of non-MACE group(P<0.05).While the heart rate,GRACE score,serum BNP and HbA1c levels of the MACE group were significantly higher than those of non-MACE group(P<0.05).Multivariate logistic regression analysis showed that the history of heart failure,GRACE score,serum levels of BNP and HbA1C were independent risk factors for MACE in patients with ACS after PCI(P<0.05).The area under the curve(AUC)of GRACE score,BNP and HbA1C for predicting the in-hospital MACE after PCI in ACS patients were 0.758,0.838 and 0.788,respectively.The AUC of GRACE score combined with BNP and HbA1C was 0.876(Z=4.142,P<0.001).Conclusion GRACE score combined with BNP and HbA1c significantly improve the predictive value for in-hospital MACE in ACS patients after PCI compared with traditional

关 键 词：GRACE评分 脑钠肽 糖化血红蛋白 急性冠脉综合征 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病]