BNP、hs-cTnT、GDF-15、Copeptin、PTX-3联合GRACE评分对高龄NSTACS左心收缩功能正常患

发布时间：2018-06-27 18:49

本文选题：B型利钠肽 + 高敏肌钙蛋白T　；参考：《青岛大学》2015年博士论文

【摘要】：目的:探讨生化标记物BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3以及联合GRACE评分对高龄非ST抬高型急性冠脉综合征(NSTACS)左心收缩功能正常患者1年终点事件的风险评估价值,并探讨BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3不同水平早期介入治疗的作用。方法:选择年龄≥75岁NSTACS肌钙蛋白T、左心收缩功能正常患者204例,男性95例,女性109例,平均发病时间8.3±2.4小时,平均年龄78.1±2.0岁。对所有患者测定BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平,并随机分为早期介入组与药物保守组,对早期介入组48小时内行冠脉造影,记录冠脉病变支数、病变程度,计算Gensini积分。对所有患者随访1年,观察1年终点事件(非致死性心梗、心血管死亡)。通过生存曲线、COX模型、ROC曲线分析BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3与1年终点事件的关系,以及联合GRACE评分对1年终点事件的风险评估价值,并用"緼UC、IDI、NRI统计学指标进行比较。同时对早期介入组与药物保守组BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3不同水平终点事件进行比较分析。结果:1.三支、双支血管病变患者BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平高于单支血管病变患者(P0.05),冠脉完全闭塞、重度狭窄患者高于轻度、中度狭窄患者(P0.05),与Gensini积分呈正相关性。2.1年终点事件患者BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平均高于未发生终点事件的患者(P0.05);BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3高水平患者生存时间小于低水平患者(P=0.004;P=0.017;P=0.004;P=0.018;P=0.010)。3.COX模型分析BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3高水平患者1年终点事件风险分别为4.339(95%CI 1.114-15.091,P=0.014)、4.571(95%CI1.152-15.873,P=0.012)、4.273(95%CI 1.056-14.147,P=0.016)、2.640(95%CI1.037-10.773,P=0.044)、3.753(95%CI 1.093-13.801,P=0.027),并独立于GRACE评分。4.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3预测1年终点事件的ROC曲线下面积分别为0.689(95%CI 0.656-0.763)、0.696(95%CI 0.667-0.797)、0.717(95%CI0.684-0.825)、0.690(95%CI 0.661-0.779)、0.715(95%CI 0.673-0.819),与GRACE评分ROC曲线下面积比较无差异(P0.05)。5.BNP联合GRACE评分预测1年终点事件ROC曲线下面积为0.741(95%CI 0.711-0.856),"緼UC为0.034(95%CI 0.006-0.053),IDI为0.028(95%CI 0.013-0.042),NRI(0)为0.410(95%CI 0.111-0.638);hs-c Tn T联合GRACE评分ROC曲线下面积为0.722(95%CI 0.696-0.814),"緼UC为0.015(95%CI0.001-0.027),IDI为0.010(95%CI 0.001-0.018),NRI(0)为0.428(95%CI0.202-0.654);GDF-15联合GRACE评分ROC曲线下面积为0.745(95%CI 0.712-0.873),"緼UC为0.038(95%CI 0.007-0.058),IDI为0.034(95%CI 0.015-0.062),NRI(0)为0.454(95%CI 0.229-0.679);Copeptin联合GRACE评分ROC曲线下面积为0.730(95%CI0.703-0.828),"緼UC为0.023(95%CI 0.004-0.039),IDI为0.015(95%CI0.008-0.026),NRI(0)为0.351(95%CI 0.125-0.576);PTX-3联合GRACE评分ROC曲线下面积为0.736(95%CI 0.710-0.841),"緼UC为0.029(95%CI 0.005-0.042),IDI为0.018(95%CI 0.004-0.030),NRI(0)为0.395(95%CI 0.167-0.622)。6.早期介入组1年终点事件发生率低于药物保守组,生存时间长。两组hs-c Tn T、GDF-15、PTX-3不同水平患者1年终点事件比较有差异(P0.05),而两组BNP、Copeptin不同水平患者1年终点事件比较无差异(P0.05)。结论:1.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3与高龄NSTACS左心收缩功能正常患者冠脉病变程度密切相关。2.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3可预测高龄NSTACS左心收缩功能正常患者1年终点事件风险,BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平越高,1年终点事件风险越高,联合GRACE评分,可增强GRACE评分风险预测能力,其中GDF-15、BNP联合GRACE评分风险预测能力较强。3.早期介入治疗能降低高龄NSTACS左心收缩功能正常GDF-15、hs-c Tn T、PTX-3高水平患者发生终点事件的风险,对早期介入治疗有指导意义;但介入治疗不能降低高龄NSTACS左心收缩功能正常BNP、Copeptin高水平患者发生终点事件的风险,对早期介入治疗无指导意义,对如何降低高龄NSTACS左心收缩功能正常BNP、Copeptin高水平患者发生终点事件的风险,需要进一步探讨。
[Abstract]:Objective: To evaluate the value of biochemical markers BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 and combined GRACE score on the risk assessment of the 1 year endpoint events in patients with normal left heart systolic function in elderly patients with non ST elevation acute coronary syndrome (NSTACS) and explore the role of BNP, HS-C, and different levels of early intervention. The patients aged 75 and 75 years old, 204 cases of normal left cardiac contractile function, 95 men and 109 women, average age 8.3 + 2.4 hours, average age 78.1 + 2 years. All patients were measured BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 level, and randomly divided into early intervention group and drug conservative group, for the early intervention group 48 hours. Internal coronary angiography, record coronary artery disease count, degree of lesion, and calculate Gensini score. Follow up to all patients for 1 years, observe 1 year endpoint events (non lethal myocardial infarction, cardiovascular death). Analyze the relationship between BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 and 1 year end events through the survival curve, COX model, ROC curve, and the combined GRACE score to 1 The value of risk assessment of year-end point events was compared with "UC, IDI, NRI statistics". At the same time, the results were compared between the early intervention group and the conservative group BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3. Patients with vascular lesions (P0.05) were completely blocked and patients with severe stenosis were higher than mild, moderate stenosis patients (P0.05), and Gensini scores were positively correlated with BNP, HS-C Tn T, GDF-15, Copeptin, and PTX-3 level in patients with.2.1 year end events. The time less than low level (P=0.004; P=0.017; P=0.004; P=0.018; P=0.010).3.COX model analysis BNP, HS-C Tn T, GDF-15, Copeptin, the risk of the 1 year end event of the high level patients was 4.339, 4.571 (95%), 4.273 044), 3.753 (95%CI 1.093-13.801, P=0.027), and independent of the GRACE score.4.BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 prediction 1 year end events under the ROC curve area of 0.689, 0.696 (95%), 0.690 (95%), 0.715 (0.715), and 0.715 The lower area (P0.05).5.BNP combined GRACE score predicted that the area under the ROC curve of the 1 year end event was 0.741 (95%CI 0.711-0.856), "UC was 0.034 (95%CI 0.006-0.053), IDI was 0.028 (95%CI 0.013-0.042), and 0) was 0.410. For 0.015 (95%CI0.001-0.027), IDI is 0.010 (95%CI 0.001-0.018), NRI (0) is 0.428 (95%CI0.202-0.654); the area under ROC curve of GDF-15 combined GRACE score is 0.745 (95%CI 0.712-0.873) and 0.034 (0) is 0.454. The product is 0.730 (95%CI0.703-0.828), "UC is 0.023 (95%CI 0.004-0.039), IDI is 0.015 (95%CI0.008-0.026), NRI (0) is 0.351 (95%CI 0.125-0.576); PTX-3 United GRACE score is 0.736 under ROC curve," 0.029 (95%). 0) is 0.395. The incidence of 1 year endpoints in the early intervention group was lower than that in the conservative group, and the survival time was longer. The 1 year end events of the two groups of HS-C Tn T, GDF-15 and PTX-3 were different (P0.05), while the 1 year end events of the two groups of BNP and Copeptin were no difference (P0.05). The degree of coronary lesions in patients with normal left cardiac contractile function is closely related to the degree of coronary artery disease (.2.BNP), HS-C Tn T, GDF-15, Copeptin, and PTX-3 can predict the risk of 1 year endpoint event in patients with normal systolic function in the elderly, BNP, HS-C Tn, the higher the level, the higher the risk of the end of the 1 year. Test ability, of which GDF-15, BNP combined with GRACE scoring risk prediction ability,.3. early intervention therapy can reduce the elderly NSTACS left cardiac contractile function normal GDF-15, HS-C Tn T, PTX-3 high level patients have the risk of endpoint events, the early intervention therapy has guidance significance, but the introduction of treatment can not reduce the age NSTACS left ventricular systolic function normal B. The risk of endpoint events in NP, Copeptin high level patients is not instructive for early intervention therapy. It is necessary to further explore how to reduce the risk of end-point events in patients with advanced NSTACS left cardiac contractile function and Copeptin high level patients.
【学位授予单位】：青岛大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R541.4

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