NT-proBNP联合冠脉钙化总积分对老年稳定性冠心病患者预后风险评估

发布时间：2018-11-13 19:55

【摘要】：目的:探讨N末端B型利钠肽原(NT-pro BNP)联合冠脉钙化总积分(TCS)对老年稳定性冠心病(SCAD)患者预后风险评估的价值。方法:选取共264例在2013年3月-2016年1月于安徽医科大学附属省立医院老年心内科住院治疗的老年SCAD患者。其中男性、女性分别为133例、131例,入选患者年龄在60-90岁之间,再根据随访期(2-34个月)内是否发生主要不良心血管事件(MACE)来分组,即非MACE组(n=151)和MACE组(n=113)。采用Roche Elecsys2010全自动免疫分析仪(德国)及Roche试剂盒测定血浆NT-pro BNP水平;采用美国通用电器公司(GE)生产的64排128层螺旋CT对患者进行冠状动脉CT平扫,采集数据后将扫描得到的图像传到工作站,利用自带的Smartscore软件计算TCS。运用多种统计学分析将两种指标联合建立综合预测模型来实现对老年SCAD患者发生MACE的评估。结果:1.非MACE组和MACE组的年龄、性别、BMI、吸烟史、高血压病史、糖尿病病史、血脂异常史间差异均无统计学意义(P0.05);2.MACE组的NT-pro BNP和TCS均高于非MACE组,差异有统计学意义(P0.05);3.构建Logistic回归模型:Logit(P)=-2.602+0.001NT-proBNP+0.010TCS,得到新联合指标Logit(P)。新联合指标Logit(P)预测老年SCAD患者发生MACE的受试者工作特征(ROC)曲线下面积(AUC)为0.891[95%CI(0.847,0.926),P0.01)],灵敏度和特异度分别为0.788、0.848;4.NT-proBNP预测老年SCAD患者发生MACE的AUC为0.770[95%CI(0.715,0.820),P0.01],灵敏度和特异度分别为0.549、0.808;5.TCS预测老年SCAD患者发生MACE的AUC为0.833[95%CI(0.782,0.876),P0.01],灵敏度和特异度分别为0.779、0.755;6.新联合指标与NT-proBNP、TCS预测老年SCAD患者发生MACE的AUC比较,差异均有统计学意义(Z值分别为4.83、2.63,P0.01);7.NT-pro BNP与TCS预测老年SCAD患者发生MACE的AUC比较,差异无统计学意义(Z=1.56,P=0.12)。结论:NT-proBNP联合TCS对老年SCAD患者预后风险评估的价值高于其中任一单个指标,为老年SCAD患者不良预后早期预测提供更可靠的方法。
[Abstract]:Objective: to evaluate the prognostic value of N-terminal B-type natriuretic peptide (NT-pro BNP) combined with total coronary calcification score (TCS) in elderly patients with stable coronary heart disease (SCAD). Methods: a total of 264 elderly SCAD patients who were hospitalized in the Department of Geriatric Cardiology, Provincial Hospital of Anhui Medical University from March 2013 to January 2016 were selected. There were 133 male and 131 female patients aged between 60 and 90. They were grouped according to whether or not major adverse cardiovascular events (MACE) occurred during the follow-up period (2-34 months). They were non-MACE group (nn-151) and MACE group (n-113). Plasma NT-pro BNP levels were measured by Roche Elecsys2010 automatic immunoanalyzer (Germany) and Roche kit. A 64-row 128-layer spiral CT produced by (GE) was used to scan the coronary artery CT of patients. After collecting the data, the images were transmitted to the workstation, and the TCS. was calculated by using the Smartscore software. Multiple statistical analyses were used to establish a comprehensive predictive model to evaluate the incidence of MACE in elderly patients with SCAD. The result is 1: 1. There was no significant difference in age, sex, history of BMI, smoking, history of hypertension, history of diabetes mellitus and history of dyslipidemia between non MACE group and MACE group (P0.05). The NT-pro BNP and TCS of 2.MACE group were significantly higher than that of non-MACE group (P0.05). Logistic regression model: Logit (P) =-2.602 0.001NT-proBNP 0.010 TCSA was constructed and a new combined index Logit (P). Was obtained. The area under the (ROC) curve of Logit (P) was 0.891 [95%CI (0.847 ~ 0.926), P0.01), the sensitivity and specificity were 0.788 卤0.848, respectively, but the area under the (ROC) curve was 0.891 [95%CI (0.847 ~ 0.926), P0.01)]. The AUC of 4.NT-proBNP in predicting the incidence of MACE in the elderly patients with SCAD was 0.770 [95%CI (0.715 ~ 0.820), P0.01], the sensitivity and specificity were 0.549 ~ 0.808, respectively. The AUC of 5.TCS in predicting the incidence of MACE in elderly patients with SCAD was 0.833 [95%CI (0.782n 0.876), P0.01], and the sensitivity and specificity were 0.755 ~ (6) ~ (6), respectively. There were significant differences in AUC between the new combined index and NT-proBNP,TCS in predicting the incidence of MACE in elderly patients with SCAD (Z = 4.83 卤2.63, P0.01). There was no significant difference between 7.NT-pro BNP and TCS in predicting MACE AUC in elderly patients with SCAD (Z 1.56 P < 0.12). Conclusion: the value of NT-proBNP combined with TCS in evaluating the prognostic risk of elderly patients with SCAD is higher than that of any single index, which provides a more reliable method for early prediction of poor prognosis in elderly patients with SCAD.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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