心肌肌钙蛋白I、N末端B型利钠肽原联合国家早期预警评分对心血管急重症患者近期预后的评估价值  

The prognostic value of the combination of national early warning score,cTnI and NT-proBNP in critically ill patients with acute cardiovascular disease

作　　者：杨鲁 陈曦[2] 张新超[2] Yang Lu;Chen Xi;Zhang Xinchao(Emergency Department,Qingdao Municipal Hospital(Group),Qingdao 266071,China;Emergency Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,P.R.China,Beijing 100730,China)

机构地区：[1]青岛市市立医院急诊科,266071 [2]北京医院急诊科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中国心血管杂志》2022年第6期513-518,共6页Chinese Journal of Cardiovascular Medicine

基　　金：卫生行业科研专项基金(201002011)。

摘　　要：目的探讨心肌肌钙蛋白I(cTnI)、N末端B型利钠肽原(NT-proBNP)联合国家早期预警评分(NEWS)对心血管急重症患者近期预后的评估作用。方法连续入选2013年9月至2015年7月北京医院急诊科抢救室收治的222例心血管急重症患者。记录患者的一般情况、入抢时生命体征和意识状态,对其进行NEWS评分;并检测静脉血cTnI、NT-proBNP水平;随访30 d,根据预后分为存活组和死亡组。通过多因素回归分析、绘制受试者工作特征(ROC)曲线、计算ROC曲线下面积(AUC值)评价cTnI、NT-proBNP、NEWS评分及联合检测对患者预后的评估价值。结果心血管急重症患者死亡组与存活组的cTnI、NT-proBNP和NEWS评分比较,差异均有统计学意义(均为P<0.05)。多因素回归分析显示,cTnI、NT-proBNP和NEWS评分均为30 d死亡风险的独立预测因子(均为P<0.05),其AUC值分别为0.669、0.724和0.706,三者之间比较无统计学差异(P>0.05);三者的临界值分别为0.03 ng/ml、3197 pg/ml和7分,高于临界值水平,患者30 d死亡率较高;高于临界值项目越多,患者30 d死亡率越高。cTnI、NT-proBNP联合NEWS评分的AUC值明显高于单独应用NEWS评分的AUC值(0.764、0.786比0.706,均为P<0.05);三者联合的AUC值最大,为0.809,明显高于三者单独应用的AUC值(均为P<0.05)。结论cTnI、NT-proBNP、NEWS评分均为心血管急重症患者30 d不良预后的独立预测因子。cTnI、NT-proBNP联合NEWS评分可明显提高评估患者不良预后的价值,而三者皆升高对30 d不良预后的评估意义最大。Objective To evaluate the short-term prognostic value of national early warning score(NEWS)combined with cTnI and NT-proBNP in critically ill patients with cardiovascular disease.Methods A total of 222 patients with acute severe cardiovascular disease in the emergency room of Beijing Hospital from September 2013 to July 2015 were consecutively enrolled.General condition,vital signs and state of consciousness on admission of emergency room were recorded,the NEWS score was calculated and serum cTnI and NT-proBNP were examined.The patients were followed up at 30thday.All were divided into survival group and death group.The prognostic values of cTNI,NT-proBNP,NEWS,NEWS combined with cTnI and(or)NT-proBNP were evaluated by multivariate regression analysis,ROC curve,and area under the curve(AUC value).Results There were significant differences in cTnI,NT-proBNP and NEWS between the death group and the survival group(all P<0.05).Multivariate regression analysis showed that cTnI,NT-proBNP and NEWS were all independent predictors of 30-day mortality risk(all P<0.05).The AUC of the three groups were 0.669,0.724 and 0.706,respectively,which did not show significant difference among the three groups(P>0.05).The cut-off of the three factors were 0.03 ng/ml,3197 pg/ml,and 7,respectively.The 30-day mortality rate of patients above the cut-off level was higher.The more items above the cut-off value,the higher 30-day mortality rate.The AUC of NEWS combined with cTnI or NT-proBNP was significantly higher than that of NEWS alone(0.764 vs.0.706,0.786 vs.0.706,both P<0.05).The AUC of the three factors’combination was 0.809,which was significantly higher than those of single factor(all P<0.05).Conclusions cTnI,NT-proBNP,and NEWS are all independent predictors of 30-day poor outcome of the patients with acute and severe cardiovascular disease.The NEWS combined with cTnI or NT-proBNP can significantly improve the prognostic value of NEWS,and the increased level of all three factors has the highest prognostic value on poor prognosis at

关 键 词：国家早期预警评分 心肌肌钙蛋白I N末端B型利钠肽原 死亡率 

分 类 号：R54[医药卫生—心血管疾病]