NT-proBNP、cTnI、aVL导联T波改变对急性冠状动脉综合征患者预后的预测价值  

Prognostic value of lead T-wave changes of NT-proBNP,cTnI and aVL in patients with acute coronary syndrome

作　　者：王新艳[1] 肖子亚 李勇[1] 郭延吉 Wang Xinyan;Xiao Ziya;Li Yong;Guo Yanji(Department of Emergency,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院急诊科,济宁272029

出　　处：《中国医师杂志》2024年第11期1637-1641,共5页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(202010000964)。

摘　　要：目的探讨N末端B型脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、aVL导联T波改变对急性冠状动脉综合征(ACS)预后预测的价值。方法回顾性收集2020年1月至2021年12月就诊于济宁医学院附属医院急诊胸痛中心的162例ACS患者临床资料, 其中不稳定心绞痛(UAP)患者84例, ST段抬高型心肌梗死(STEMI)患者46例, 非ST段抬高型心肌梗死(NSTEMI)患者32例;单支病变患者66例, 双支病变患者70例, 多支病变26例, 发生主要心血管不良事件(MACE)51例。比较不同患者NT-proBNP、cTnI水平及aVL导联T波改变比例的差异。结果 UAP患者NT-proBNP、cTnI分别为510.42(365.56, 630.54)pg/ml和8.20(6.50, 10.50)ng/ml, 明显低于STEMI和NSTEMI患者(均P<0.05);STEMI和NSTEMI患者NT-proBNP、cTnI比较差异无统计学意义(均P>0.05);多支病变患者NT-proBNP、cTnI及aVL导联T波改变比例分别为804.90(680.87, 980.05)pg/ml、13.90(10.12, 15.65)ng/ml和88.46%(23/26), 明显高于单支和双支病变患者(均P<0.05);双支病变患者NT-proBNP、cTnI及aVL导联T波改变比例分别为680.84(525.50, 810.62)pg/ml、10.40(8.92, 13.60)ng/ml和67.14%(47/70), 明显高于单支病变患者(均P<0.05);发生MACE患者NT-proBNP、cTnI及aVL导联T波改变比例分别为744.54(621.17, 905.54)pg/ml、12.21(8.65, 15.54)ng/ml和86.27%(44/51), 明显高于未发生MACE患者(均P<0.05);NT-proBNP、cTnI、aVL导联T波改变单独及联合预测MACE发生的ROC曲线下面积分别为0.937、0.677、0.706和0.799, 其中NT-proBNP预测MACE发生的价值较高。结论 NT-proBNP、cTnI及aVL导联T波改变与ACS患者病变类型、病变支数和MACE的发生有关, 其中NT-proBNP预测预后具有较高的应用价值。Objective To investigate the prognostic value of N-terminal B-type brain natriuretic peptide precursor(NT-proBNP),cardiac troponin I(cTnl)and aVL lead T-wave changes in acute coronary syndrome(ACS).Methods Clinical data of 162 patients with ACS admitted to the Emergency Chest Pain Center of the Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were retrospectively collected,including 84 patients with unstable angina pectoris(UAP)and 46 patients with ST-segment elevation myocardial infarction(STEMI).32 patients with non-ST elevation myocardial infarction(NSTEMI);There were 66 patients with single-vessel disease,70 patients with double-vessel disease,26 patients with multi-vessel disease,and 51 patients with major cardiovascular adverse events(MACE).The levels of NT-proBNP,cTnI and T-wave change ratio of aVL lead were compared in different patients.Results The NT-proBNP and cTnl of UAP patients were 510.42(365.56,630.54)pg/ml and 8.20(6.50,10.50)ng/ml,respectively,which were significantly lower than those of STEMI and NSTEMI patients(all P<0.05).There was no significant difference in NT-proBNP and cTnI between STEMI and NSTEMI patients(all P>0.05).The T-wave change proportions of NT-proBNP,cTnl and aVL leads in patients with multi-vessel lesions were 804.90(680.87,980.05)pg/ml,13.90(10.12,15.65)ng/ml and 88.46%(23/26),respectively.It was significantly higher than that in patients with single and double vessel lesions(all P<0.05).The T-wave change ratio of NT-proBNP,cTnl and aVL leads in patients with double-vessel disease was 680.84(525.50,810.62)pg/ml,10.40(8.92,13.60)ng/ml and 67.14%(47/70),respectively,which was significantly higher than that in patients with single-vessel disease(all P<0.05).The proportions of T-wave changes of NT-proBNP,cTnI and aVL leads in MACE patients were 744.54(621.17,905.54)pg/ml,12.21(8.65,15.54)ng/ml and 86.27%(44/51),respectively.It was significantly higher than those without MACE(all P<0.05).The area under receiver operating characteristic(ROC)curve

关 键 词：急性冠状动脉综合征 肌钙蛋白I N末端B型脑钠肽前体 心电描记术 

分 类 号：R541.4[医药卫生—心血管疾病]