联合LVEF和NT-proBNP检测在症状不典型非ST抬高性急性冠脉综合征早期预后评估中的作用

发布时间：2018-05-18 06:24

  本文选题：N末端脑钠肽原 + 左心室射血分数　； 参考：《实用医学杂志》2017年14期

【摘要】：目的探讨N末端脑钠肽原(NT-proBNP)和左心室射血分数(LVEF)在症状不典型非ST抬高性急性冠脉综合征(NSTE-ACS)早期预后评估中的价值。方法回顾性分析2015年1月1日至2016年6月31日经急诊确诊并入院的248例急性心肌梗死的患者资料,按照心电图改变分为NSTE-ACS和STE-ACS组,分别记录其年龄、性别、既往病史、吸烟史、就诊症状、是否表现为胸痛、从发病到就诊时间(院前时间)、从就诊到接受经皮冠状动脉介入(PCI)或溶栓等治疗的时间(急诊时间)、28 d是否死亡,如果死亡则记录发病至死亡的时间(生存时间);记录患者来急诊即接受的检查的结果,包括血常规、心肌损伤标志物(CK-MB\MYO\CTNI)、D-二聚体、NT-proBNP、LVEF等指标,进行多因素Logistic回归分析并绘制受试者工作特征曲线(ROC曲线),同时建立Cox回归模型,并绘制生存曲线,以分析NT-proBNP和LVEF对心梗后早期预后(28 d死亡)的预测价值。结果对NSTE-ACS和STE-ACS组分析发现,NSTE-ACS组以胸痛为主诉就诊的患者比例低于后者(33.6%vs.70.1%,P=0.003),院前时间长于后者(67.92±116.89 vs.30.65±55.59,P=0.006),CTNI(4.37±12.53 vs.9.62±18.00,P=0.011)和LVEF(53.51±14.51 vs.56.26±12.30,P=0.019)低于后者,NT-proBNP高于后者(2 288.37±4 612.10 vs.1 506.84±1 722.51,P=0.038),而病死率高于前者(15.3%vs.6.8%,P=0.036)。Logistic回归方程分析提示LVEF与28 d病死率负相关(B=-0.097,P=0.022),ROC曲线下面积0.783,NT-pro BNP与LVEF进行拟合后绘制ROC曲线下面积0.901,提示评价效果优于单一因素。且NT-proBNP与LVEF呈负相关(r=-0.263,P=0.001),Cox回归模型生存曲线提示LVEF(B=0.401,P=0.045)越大,生存时间越长,NT-proBNP(B=0.00,P=0.931)与生存时间无关。结论联合LVEF和NT-proBNP检测有助于临床医师早期对症状不典型的NSTE-ACS患者的危险程度作出评估,以改善患者的预后。
[Abstract]:Objective to investigate the value of NT-proBNPs and left ventricular ejection fraction (LVEF) in the early prognostic evaluation of atypical ST-elevation acute coronary syndrome (ACS). Methods from January 1, 2015 to June 31, 2016, the data of 248 patients with acute myocardial infarction were analyzed retrospectively. According to the changes of ECG, they were divided into NSTE-ACS group and STE-ACS group. Their age, sex, medical history and smoking history were recorded respectively. The symptoms of the visit were chest pain, the time from onset to visit (pre-hospital time), from visit to percutaneous coronary intervention (PCI) or thrombolytic therapy (emergency time was 28 days). If the patient died, the time from onset to death (survival time) was recorded. The results of the emergency examination were recorded, including blood routine examination, myocardial injury marker CK-MB\ MYO\ CTNININ D- dimer NT-proBNPN LVEF, and so on. Multivariate Logistic regression analysis was performed and the operating characteristic curve of subjects was drawn. Meanwhile, Cox regression model was established and survival curve was drawn to analyze the predictive value of NT-proBNP and LVEF for early prognosis of 28 days after myocardial infarction (MI). 缁撴灉瀵筃STE-ACS鍜孲TE-ACS缁勫垎鏋愬彂鐜，

本文编号：1904770