急性冠状动脉综合征患者NT-proBNP界值点的意义

目的探讨急性冠状动脉综合征（ACS）患者氨基末端B型钠尿肽原（NT-proBNP）界值点的意义。方法采用Roche Modu lar E170全自动电化学发光免疫分析仪测定292例住院患者入院时血清NT-proBNP水平,记录随访10个月间患者再次发生主要不良心血管事件的情况。应用受试者工作特征曲线确定NT-proBNP水平截断点,根据该值将患者危险分层分为高危组（141例）和低危组（151例）。结果血清NT-proBNP水平危险分层的最佳截断点取608 ng/L,其敏感性为81.3%,特异性为61.7%。高危组中发生不良心血管事件54例（38.3%）,无事件者为87例（61.7%）;而低危组中发生不良心血管事件11例（7.3%）、无事件者为140例（92.7%）。高危组预后情况较低危组更差[P〈0.001,相对危险度（RR）：5.25,95%可信区间（CI）：2.60-10.59]。结论血清NT-proBNP水平对ACS患者危险分层的最佳截断点为608 ng/L。     

氨基末端脑钠肽前体对不同危险分层非ST段抬高型急性冠状动脉综合征患者远期预后的评估价值

目的探讨氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)对不同危险分层非ST段抬高型急性冠状动脉综合征(non-ST-elevation acute coronary syndrome,NSTEACS)患者远期预后的评估价值。方法 NSTEACS患者75例依据危险分层分为低危25例(低危组),中危25例(中危组),高危25例(高危组),同期住院非急性冠状动脉综合征患者25例为对照组;比较入院即刻、入院24h及7d4组血清NT-proBNP、肌钙蛋白T和高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平;随访1a,观察4组病死率及心血管事件发生率。结果高危组各时间点NT-proBNP、肌钙蛋白T和hs-CRP水平高于中、低危组及对照组(P<0.05);NSTEACS患者入院即刻、入院24h及7dNT-proBNP水平与肌钙蛋白T水平呈正相关(P<0.05),与入院即刻、入院24h时hs-CRP水平呈正相关(P<0.05);高危组心血管事件发生率高于中、低危组(P<0.05)。结论 NT-proBNP可作为NSTEACS不同危险分层远期预后的一项评价指标。     

NT-proBNP对慢性肾功能不全合并慢性心力衰竭患者危险分层价值的研究

目的:探讨血浆中氨基末端脑钠肽前体(NT-proBNP)对慢性肾功能不全(chronic renal insufficiency,CRI)合并慢性心力衰竭(chronic heart failure,CHF)患者的危险分层价值。方法:以CRI合并CHF的97例患者为研究对象,根据血浆NT-proBNP水平将患者分为高危组53例、非高危组44例(中危组25例,低危组19例),以同期体检健康的41例为对照组。比较各组高敏肌钙蛋白T(hs-cTnT)及经多普勒超声心动图检测的左心室射血分数(LVEF)。结果:高危组NT-proBNP和hs-cTnT均明显高于非高危组[(5611.40±1790.28)ng/L vs(1302.75±195.57)ng/L,P0.01]和[(131.22±40.98)ng/L vs(46.56±13.80)ng/L,P0.01],而高危组明显LVEF明显低于非高危组[(31.81±9.02)%vs(65.32±10.73)%,P0.05];非高危组NT-proBNP和hs-cTnT明显高于对照组[(1302.75±195.57)ng/L vs(187.68±39.61)ng/L,P0.05]和[(46.56±13.80)ng/L vs(16.11±4.53)ng/L,P0.05],而非高危组LVEF与对照组无明显差异[(65.32±0.73)%vs(68.32±0.51)%,P0.05]. Pearson直线相关分析示:高危组NT-proBNP水平与hs-cTnT水平呈正相关(r=0.93,P0.01),而与LVEF呈负相关(r=-0.45,P0.05),非高危组NT-proBNP水平与hs-cTnT水平呈正相关(r=0.82,P0.01),而与LVEF亦呈负相关(r=-0.41,P0.05).制订NTproBNP危险分层指数为4400 ng/L,是诊断CRI合并CHF的最佳截点,具有较好的敏感性(82.1%)、特异性(84.6%)及准确度(86.3%)。结论 CRI合并CHF患者血浆中NT-proBNP水平显著升高,hs-cTnT,LVEF发生相应改变,制订出NT-proBNP危险分层指数对CRI合并CHF患者危重程度的诊治具有一定的临床价值。     

氨基末端B型利钠肽前体与D-二聚体和肌钙蛋白I在急性肺栓塞患者中的应用价值

目的探讨氨基末端B型利钠肽前体(NT-proBNP)与D-二聚体(D-Dimer)和肌钙蛋白I(cTnI)在急性肺栓塞(APE)患者中的应用价值。方法回顾性分析145例经肺动脉CT血管造影确诊的APE患者,同时行超声心动图、NT-proBNP、cTnI、D-Dimer检查,排除可能影响NT-proBNP、cTnI、D-Dimer浓度的疾病。根据肺栓塞危险分层分为高危组、中高危组、中低危组、低危组。结果血浆NT-proBNP浓度在高危组、中高危组、中低危组均显著高于低危组(P<0.05),NT-proBNP与肺栓塞危险分层呈正相关(r=0.618,P<0.05),单独检测可用于预测右心室功能不全,最佳截断值为1305 ng/L,敏感性和特异性分别为69.2%和69.9%(AUC=0.751,95%CI:0.672~0.819,P<0.05)。D-Dimer浓度在高危组、中高危组、中低危组与低危组间差异均无统计学意义(P>0.05),D-Dimer浓度与危险分层无相关性(r=0.078,P>0.05),预测右心室功能不全的效能较差(AUC=0.569,95%CI:0.485~0.651,P>0.05)。cTnI浓度在高危组、中高危组、中低危组均高于低危组(P<0.05),与危险分层呈正相关(r=0.303,P<0.05),预测右心室功能不全的最佳截断值为0.20μg/L,敏感性和特异性分别为82.7%和40.9%(AUC=0.655,95%CI:0.571~0.732,P<0.05)。联合检测NT-proBNP、cTnI预测右心室功能不全(RVD)效能优于单独检测(AUC=0.778,95%CI:0.701~0.842,P<0.05)。结论血浆NT-proBNP、cTnI水平随着危险分层增加而升高,对于鉴别APE患者是否合并RVD有一定价值,可用于肺栓塞患者的危险分层、预后判断。D-Dimer浓度与肺栓塞危险分层无相关性,预测RVD效能较差。     

急性心力衰竭患者血清可溶性ST2受体及N末端B型脑钠肽前体水平变化及意义

目的探讨急性心力衰竭(acute heart failure, AHF)患者血清可溶性ST2受体(soluble ST2, sST2)、N末端B型脑钠肽前体(N-terminal B-type brain natriuretic peptide precursor, NT-proBNP)水平变化及其在病情评估中的价值。方法 AHF患者128例(AFP组),其中NYHA心功能Ⅱ级48例、Ⅲ级41例、Ⅳ级39例,同期45例体检健康者为对照组。检测各组血清sST2、NT-proBNP水平;对AHF患者给予规范性治疗并随访6个月,47例发生不良事件者为不良事件组,81例未发生不良事件者为无不良事件组,比较2组一般资料、血脂及血清ST2、NT-proBNP水平,多因素logistic回归分析AHF患者发生不良事件的影响因素,绘制ROC曲线评估血清sST2、NT-proBNP预测AHF患者近期发生不良事件的效能。结果 AHF组血清sST2[(83.4±10.6)μg/L]、NT-proBNP[(4 416.5±433.2)ng/L]水平高于对照组[(42.9±7.6)μg/L、(164.1±36.3)ng/L](P<0.05);NYHA心功能Ⅱ、Ⅲ、Ⅳ级患者血清sST2[(74.7±9.8)、(95.3±14.2)、(131.5±18.7)μg/L]、NT-proBNP[(3 127.9±379.9)、(4 607.7±422.1)、(5 835.4±497.8)ng/L]水平依次增高(P<0.05);不良事件组血清sST2[(126.7±13.3)μg/L]、NT-proBNP[(5 265.8±470.6)ng/L]水平高于无不良事件组[(75.6±10.4)μg/L、(3 461.6±379.4)ng/L](P<0.05),NYHA心功能Ⅳ级比率(46.81%)高于无不良事件组(20.99%)(P<0.05);多因素logistic回归分析结果显示,血清sST2(OR=3.207,95%CI:1.908~4.271,P=0.011)、NT-proBNP(OR=3.416,95%CI:2.302~4.818,P=0.006)是AHF患者发生不良事件的影响因素;ROC曲线分析结果显示,sST2以93.6μg/L为最佳截断值,预测不良事件的AUC为0.809(95%CI:0.728~0.912,P<0.05),灵敏度为81.1%,特异度为74.3%;NT-proBNP以4 152.7 ng/L为最佳截断值,预测不良事件的AUC为0.839(95%CI:0.766~0.981,P<0.05),灵敏度为60.5%,特异度为94.1%;sST2联合NT-proBNP预测不良事件的AUC为0.846(95%CI:0.773~0.912,P=0.027),灵敏度为86.7%,特异度为94.3%。结论 AHF患者血清ST2、NT-proBNP水平随心功能分级升高而增高;血清ST2、NT-proBNP与AHF患者发生不良事件有关,可作为评估AHF病情和近期预后的有效指标。     

H-FABP、NT-proBNP、CRP、cTnT在ACS患者预后中的评估价值

目的探讨分析H-FABP、NT-proBNP、CRP、cTnT在ACS患者预后中的评估价值。方法 96例ACS患者根据随访1年内患者是否发生不良心血管事件将所有患者分为预后不良组（35例）与对照组（61例）。于患者入院后检测H-FABP、NT-proBNP、CRP、cTnT四项指标的水平,并于出院后进行为期1年的随访,绘制受试者工作特性曲线来测定上述四项指标对ACS患者预后评估的准确性,并找出出院后发生不良心血管事件的危险因素。结果入院时预后不良组H-FABP、NT-proBNP、CRP、cTnT水平均明显高于对照组（P〈0.05）;H-FABP、NT-proBNP、CRP、cTnT检测对预测心血管不良事件的ROC曲线下面积与临界值分别为0.811、40.95μg/L,0.749、1342.98ng/L,0.788、9.69mg/L,0.812、0.78μg/L;COX单因素回归分析显示H-FABP、NT-proBNP、CRP及cTnT水平的升高是ACS患者发生心血管不良事件的危险因素（P〈0.05）。结论 H-FABP、NT-proBNP、CRP、cTnT对ACS患者的预后有着较高的评估价值,值得推广。     

IMA、HS-CTNT、CK-MB在ACS危险分层中的研究

目的研究缺血修饰清蛋白(IMA)、超敏肌钙蛋白T(HS-CTNT)、肌酸激酶同工酶(CK-MB)血清水平在急性冠状动脉综合征(ACS)危险分层中的意义。方法测定190例对照组与601例ACS患者(其中包括低危组、中危组、高危组)IMA、HS-CTNT、CK-MB的血清水平。结果低危组、中危组、高危组间IMA水平随危险程度的升高而升高,低危组与高危组之间比较差异有统计学意义(P0.05),中危组与高危组、低危组之间比较差异无统计学意义(P0.05),低危组、中危组、高危组与对照组之间比较差异有统计学意义(P0.05);低危组、中危组、高危组及对照组彼此之间HS-CTNT、CK-MB血清水平比较差异有统计学意义(P0.05),且随着危险程度的增加,HS-CTNT、CK-MB血清水平不断增高。结论 HS-CTNT、CK-MB、IMA在ACS危险分层及诊断中有一定的临床意义。     

血清sCD40L联合NT-proBNP对心力衰竭的诊断及预后评估价值研究

目的探究血清可溶性白细胞分化抗原40配体(sCD40L)联合B型尿钠肽前体(NT-proBNP)对心力衰竭的诊断及预后评估的价值。方法抽取2014年4月-2016年6月我院收治的52例心力衰竭患者作为研究组,另选取52例同期体检健康者作对照组。所有研究对象晨起时抽取其空腹状态下静脉血3.0 ml,以酶联免疫吸附试验(ELISA)对血清sCD40L、NT-proBNP水平进行测定。对比两组血清sCD40L、NT-proBNP水平、不同病变支数与血清sCD40L、NT-proBNP水平间关系及不良心血管事件与血清sCD40L、NT-proBNP水平间关系。结果研究组血清sCD40L(10.54±1.04)ng/ml、NT-proBNP(700.85±631.62)ng/L显著高于对照组[(7.46±0.61)ng/ml、(57.35±37.27)ng/L],差异有统计学意义(P0.05);双支病变组NT-proBNP(831.28±514.11)ng/L明显高于单支病变组(468.02±414.09)ng/L、三支病变组NT-proBNP(1213.51±511.51)ng/L明显高于双支病变组,具有明显差异(P0.05),三组间sCD40L相互对比均无明显差异(P0.05);发生不良心血管事件者血清sCD40L(11.44±0.87)ng/ml、NT-proBNP(1050.74±747.86)ng/L明显高于未发生不良心血管事件者[(10.41±1.02)ng/ml、(610.74±576.85)ng/L],差异有统计学意义(P0.05)。结论心力衰竭患者血清sCD40L、NT-proBNP水平显著增高,其表达水平与心衰程度呈正相关关系,联合检测两项指标可有效诊断、评估患者病情,预测病情变化情况。     

急性冠脉综合征患者血清高密度脂蛋白3与GRACE评分的相关性及其对短期风险评估的价值

目的 探讨急性冠脉综合征(ACS)患者血清高密度脂蛋白3(HDL3)水平与全球急性冠状动脉事件注册(GRACE)评分的相关性,并分析其在ACS患者短期风险评估中的临床应用价值。方法 选取2019年1月至2020年6月解放军第901医院收治的拟行冠状动脉造影术患者248例,其中ACS患者128例,冠状动脉粥样硬化患者(冠脉硬化组)56例,冠状动脉造影正常患者(冠脉正常组)64例。根据GRACE评分规则将冠状动脉异常患者分为低危组53例、中危组75例和高危组56例。采用比色法测定各组患者血清HDL3、HDL-C、LDL-C、TG、TC水平;免疫比浊法测定血清糖化血红蛋白、超敏C反应蛋白水平;Pearman相关分析评估HDL3水平与GRACE评分的相关性;ROC曲线评估血清HDL3对ACS的临床辅助诊断价值;结合术后6个月内主要不良心血管事件(MACE)分析检测血清HDL3浓度对ACS患者的短期预后价值。结果 ACS患者血清HDL3水平显著低于冠脉硬化组和冠脉正常组(P<0.001);在ACS患者中,高危组血清HDL3的表达水平显著低于中危组和低危组,而中危组显著低于低危组(P<...     

急诊冠脉介入治疗的急性ST段抬高型心肌梗死患者血浆N末端B型利钠肽原与GRACE评分的相关研究

目的 探讨经急诊冠脉介入(PCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者血浆N末端B型利钠肽原(NT-proBNP)水平与全球急性冠状动脉事件注册(GRACE)评分的关系,分析NT-proBNP对STEMI患者近期(6个月)发生心脏不良事件(MACE)的预测价值.方法 选择2008年1月-2010年12月在本院住院治疗的STEMI患者212例,入院后测定血浆NT-proBNP浓度,同时采用GRACE评分标准计算患者GRACE积分水平并进行危险分层:低危组68例,中危组78例,高危组66例;住院期间常规治疗.结果 高危组lgNT-proBNP高于中危组和低危组(P＜0.01),中危组lgNT-proBNP高于低危组(P＜0.05).STEMI患者的lgNT-proBNP水平与其GRACE评分呈正相关(r=0.56,P＜0.01).结论 STEMI患者NT-proBNP水平越高,GRACE积分越高,NT-proBNP的检测在STEMI早期危险性评估具有重要的临床价值.     

A multi-marker approach for the prediction of adverse events in patients with acute coronary syndromes

BACKGROUND: Cardiac troponin T (cTnT), high sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have emerged as strong predictors of adverse events among patients presenting with acute coronary syndromes (ACS). We evaluated the prognostic performance of each of these markers, individually, and in combination in patients presenting to the emergency department (ED) with ACS symptoms. METHODS: Serum samples were obtained from 422 consenting patients presenting to the ED with symptoms of acute coronary syndrome (ACS) and subsequently tested for cTnT, NT-proBNP, myoglobin, CK-MB, and hs-CRP. Adverse events (AEs) occurring within 30 days (death, myocardial infarction, unstable angina and the need for revascularization procedures) were recorded and ROC curves were constructed. RESULTS: AEs occurred in 42 patients (10%). Relative risk, cut-off, and predictive values for each biomarker were determined statistically, with the exception of cTnT, where the concentration meeting the 99th percentile of a healthy population with a 10% coefficient of variation (0.03 ng/ml) was used. These cut-off values, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and relative risk (RR) were calculated. Sensitivity and RR for a panel of cTnT and NT-proBNP were 78.6% (66.2-91.0) and 4.7 (2.3-9.5), respectively. CONCLUSIONS: If used alone, cTnT appeared to have greater prognostic value when compared to hs-CRP, NT-proBNP, myoglobin or CK-MB. The combination of cTnT and NT-proBNP performed better than the combination of cTnT and hs-CRP. When cTnT, NT-proBNP and hs-CRP were used as a panel, there was no significant improvement in prognostic performance over using cTnT and NT-proBNP together. Thus, in patients with suspected ACS, the measurement of both cTnT and NT-proBNP may have enhanced prognostic performance over using either marker in isolation.     

NT-proBNP水平对非ST抬高型急性冠脉综合征患者冠脉闭塞病变的诊断价值

目的:探讨N端脑钠肽前体(NT-proBNP)水平与非ST抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉闭塞病变的相关性及对病变的评估价值。方法:选取2017年12月至2019年12月泰安市中心医院收治的NSTE-ACS患者223例,根据冠脉造影的结果分为非闭塞病变组(n=156)和闭塞病变组(n=67)。分析2组NT-proBNP水平差异,采用logistic回归分析闭塞病变的危险因素,采用受试者工作特征(ROC)曲线评估NT-proBNP对闭塞病变的诊断价值。结果:与非闭塞病变组相比,闭塞病变组NT-proBNP水平显著升高,差异有统计学意义(P<0.001);多因素logistic回归分析显示,NT-proBNP水平升高是NSTE-ACS闭塞病变的危险因素(OR=1.011,95%CI 1.001~1.012,P=0.002)。NT-proBNP诊断闭塞病变的ROC曲线下方面积(AUC)为0.724(95%CI0.638~0.810),最佳界值点为149.50 ng/L,灵敏度为80.6%,特异度为61.5%。结论:在NSTE-ACS闭塞病变中,NT-proBNP水平升高,对NSTE-ACS的闭塞病变有一定诊断价值。     

N端脑钠素前体对机械通气撤机结局的预测意义

目的 探讨达到撤机条件的机械通气患者撤机前N端脑钠素前体(NT-proBNP)水平与撤机结局间的关系.方法 选择2008年8月至2009年12月重症监护病房(ICU)机械通气患者126例,统计其病因构成.在患者达到撤机条件时取血测定NT-proBNP水平,随后依次进行自主呼吸试验(SBT)并序贯撤机拔管.根据48 h内的撤机结局,比较撤机成功组与失败组NT-proBNP水平的差异,并绘制受试者工作特征曲线(ROC曲线),寻找预测撤机结局的最佳NT-proBNP水平.结果 撤机前患者的上机病因组成仍以肺部感染(占33.3%)和外科手术后(占30.2%)为主,以心力衰竭(心衰)为上机原因的仅占11.9%.撤机前患者的血浆NT-proBNP水平与撤机结局存在关联:失败组(38例)lg NT-proBNP水平较成功组(88例)明显增高(3.97±0.48比2.99±0.67,P<0.05);NT-proBNP的ROC曲线下面积为0.875±0.043,95%可信区间(95%CI)为0.792～0.959,其预测撤机失败的截点值为3 914.5 ng/L,在此截点值下的敏感性为78.3%、特异性为91.1%.结论 不论机械通气的病因如何,心功能因素在撤机时都必须考虑;3 914.5 ng/L血浆NT-proBNP水平可以预测撤机结局,达到该截点值应对患者进行改善心功能的治疗,从而提高撤机成功率.     

Lipoprotein-associated phospholipase A<Subscript>2</Subscript> for early risk stratification in patients with suspected acute coronary syndrome: a multi-marker approach

Aims Numerous markers have been identified as useful predictors of major adverse cardiac events (MACE) in patients with suspected acute coronary syndrome (ACS). However, only little is known about the relative benefit of the single markers in risk stratification and the best combination for optimising prognostic power. The aim of the present study was to define the role of the emerging cardiovascular risk marker lipoprotein-associated phospholipase A₂ (Lp-PLA₂) in a multi-marker approach in combination with troponin I (TnI), NT-proBNP, high sensitivity (hs)CRP, and D-dimer in patients with ACS. Methods and results A total of 429 consecutive patients (age 60.5±14.1 years, 60.6% male) who were admitted to the emergency room with suspected ACS were analysed in the study. Biochemical markers were measured by immunoassay techniques. All patients underwent point-of-care TnI testing and early coronary angiography if appropriate, in accordance with the current guidelines. Classification and regression trees (CART) and logistic regression techniques were employed to determine the relative predictive power of markers for the primary end-point defined as any of the following events within 42 days after admission: death, non-fatal myocardial infarction, unstable AP requiring admission, admission for decompensated heart failure or shock, percutaneous coronary intervention, coronary artery bypass grafting, life threatening arrhythmias or resuscitation. The incidence of the primary end-point was 13.1%, suggesting a mild to moderate risk population. The best overall risk stratification was obtained using NT-proBNP at a cut-off of 5000 pg/mL (incidence of 40% versus 10.3%, relative risk (RR) 3.9 (95% CI 2.4–6.3)). In the remaining lower risk group with an incidence of 10.3%, further separation was performed using TnI (cut-off 0.14 μg/L; RR= 3.1 (95% CI 1.7–5.5) 23.2% versus 7.5%) and again NT-proBNP (at a cut-off of 140 ng/L) in patients with negative TnI (RR=3.2 (95% CI 1.3–7.9), 11.7% versus 3.6%). A final significant stratification in patients with moderately elevated NT-proBNP levels was achieved using Lp-PLA₂ at a cut-off of 210 μg/L) (17.9% versus 6.9%; RR=2.6 (95% CI 1.1–6.6)). None of the clinical or ECG variables of the TIMI (Thrombolysis In Myocardial Infarction) risk score provided comparable clinically relevant information for risk stratification. Conclusions In the setting of stateof- the-art coronary care for patients with suspected ACS in the emergency room, NT-proBNP, troponin I, and Lp-PLA₂ are effective independent markers for risk stratification that proved to be superior to the TIMI risk score. Lp-PLA₂ turned out to be a more effective risk marker than hsCRP in these patients.     

氨基末端-脑钠肽前体检测对急性冠脉综合征早期诊断的意义

目的 探讨急性冠脉综合征(ACS)患者早期氨基末端-脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度的变化及其临床意义.方法 选取健康体检者15 例,稳定型心绞痛(SAP)患者15 例,ACS早期患者60 例[其中急性心肌梗死(AMI)组35例,不稳定型心绞痛(UA)组25 例].采用电化学发光免疫法(ECLIA)测定血浆NT-proBNP浓度.结果 与健康对照组NT-proBNP比较,ACS患者血浆NT-proBNP浓度明显升高(P<0.01),且AMI组NT-proBNP浓度[(1900.10±571.15)pg/mL]高于UA组[(312.78±44.47)pg/mL,P<0.01],SAP组与对照组比较差异无统计学意义.结论 血浆NT-proBNP浓度检测可为ACS早期诊断提供非常有价值的参考依据.     

NT-proBNP水平对非ST抬高型急性冠脉综合征患者冠脉闭塞病变的诊断价值

目的:探讨NT-proBNP水平与非ST抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉闭塞病变的相关性及对病变的评估价值。方法:入选符合标准的患者223例,根据冠脉造影的结果,将入选患者分为闭塞病变组和非闭塞病变组,测定两组患者的NT-proBNP水平,分析NT-proBNP水平在两组患者的差异性,对闭塞病变的相关性的危险因素进行Logistic回归分析,利用ROC曲线评估NT-proBNP 对NSTE-ACS闭塞病变的诊断价值。结果:非闭塞病变组相比,闭塞病变组NT-proBNP水平显著升高,差异具有统计学意义(P＜0.001);多因素Logistic 回归分析显示NT-proBNP水平升高是NSTE-ACS存在闭塞病变的危险因素(OR=1.011,95%CI 1.001～1.012,P=0.002)。NT-proBNP诊断闭塞病变的ROC曲线下面积为0.724(95%CI:0.638~0.810),最佳界值点为149.50 ng/L(敏感性为80.6%,特异性为61.5%)。结论： 在NSTE-ACS闭塞病变患者中,NT-proBNP水平升高,与闭塞病变的存在相关,对于NSTE-ACS病例中闭塞病变的诊断具有评估意义。     

氮末端脑钠肽前体对机械通气撤机的预测价值

目的 评价氮末端脑钠肽前体(NT-proBNP)水平对机械通气患者撤机结局的预测价值.方法 回顾性分析2014年1月～2014年12月收治于瑞金医院EICU的机械通气患者42例,统计其病因构成.根据自主呼吸试验(spontaneous breathing trial,SBT)后48 h的撤机结局,将患者分为撤机成功组和撤机失败组.比较两组患者入院时基础NT-proBNP1、SBT前NT-proBNP2、SBT后48 h的NT-proBNP3水平及SBT前72 h液体平衡的差异、并通过绘制受试者工作特征曲线(ROC曲线),分析NT-proBNP2预测撤机失败的截点值.结果 42例患者中,27例撤机成功,15例失败.两组患者既往心功能不全病史及基础NT-proBNP1水平差异无统计学意义(P=0.121);撤机失败组患者NT-proBNP2及NT-proBNP3水平均大于成功组(P =0.01,0.003);NT-proBNP2预测撤机失败的ROC曲线下面积为0.862 (95％CI:0.753～0.971),其预测撤机失败的截点为715.5 pg/mL,在此截点下敏感度93.3％,特异度74.1％.结论 患者SBT前的NT-proBNP2水平在预测撤机结局中具有一定参考价值,可作为撤机筛查指标之一.     

Relation of N-terminal pro-brain natriuretic peptide and new-onset atrial fibrillation in patients with acute coronary syndrome: a systematic review and meta-analysis

Background: Several observational studies evaluated the associations of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) and new-onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS), but the results were contradictory.

Methods: Electronic bibliographic databases were searched from inception to May 2015, and the results reviewed by two independent reviewers. Pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to assess associations between NT-proBNP levels and new-onset AF in patients with ACS. We performed sensitivity analyses to explore the potential sources of heterogeneity and estimated publication biases.

Results: Six papers, including 5861 patients (438 with AF and 5423 without AF) with ACS were analyzed. Overall, the NT-proBNP levels were higher in patients with new-onset AF than controls without AF. The SMD of the NT-proBNP levels between the patients with and those without AF was 0.53 units (95% CI 0.37–0.70), test for overall effect z-score =6.30 (p?p?=?0.02; I²?=^?62%). Further analysis revealed that differences of ethnic groups and the sample size of studies possibly account for this heterogeneity.

Conclusions: In spite of moderate heterogeneity across the enrolled studies, our meta-analysis suggests that increased NT-proBNP levels are associated with greater risk of new-onset AF with ACS, which indicates that NT-proBNP levels may be a useful biomarker in predicting new-onset AF in patients with ACS.     

N末端B型钠尿肽前体在Ⅰ型心肾综合征早期诊断中的应用价值

目的 探讨N末端B型钠尿肽前体（pro-BNP）在1型心肾综合征（CRS）中的早期诊断价值。方法 将232例急性左心衰竭患者根据是否并发CRS分成对照组（177例）及CRS组（55例）,对两组患者的一般情况进行比较,且于所有患者发病后24h左右监测血浆NT-proBNP浓度。通过ROC曲线下面积（AUC）评价血浆NT．proBNP浓度早期诊断Ⅰ型心肾综合征的价值,并找出其早期诊断Ⅰ型心肾综合征的切点。结果两组患者仅在年龄、糖尿病史及慢性心功能不全史的比较差异有统计学意义（P均〈0．05）,且CRS组患者的血浆NT-proBNP浓度明显高于对照组（P〈0．05）。血浆NT．proBNP诊断Ⅰ型心肾综合征的ROC曲线下面积是0．836（95％CI：0．775。0．898）。根据ROC曲线,NT—proBNP早期诊断Ⅰ型心肾综合征的切点值定为6000Pg／ml,此时预测Ⅰ型心肾综合征的敏感性、特异性、约登指数和准确性分别是61．8％、87．O％、0．488和81．0％,阳性预测值和阴性预测值分别为59．6％和86．5％。结论 NT-proBNP在Ⅰ型心肾综合征的早期诊断中有一定的应用价值。