N末端脑钠肽前体对冠心病的预测价值

目的 探讨N末端脑钠肽前体(NT-proBNP)对冠心病(CHD)的预测价值.方法连续选择因胸痛疑诊冠心病或已明确冠心病为进一步介入治疗的患者658例,其中经冠脉造影确诊为冠心病者484例为冠心病组,冠脉造影除外冠心病174例为对照组.记录两组的临床资料,分析冠心病危险因素及NT-proBNP、左室射血分数(LVEF)等,探讨NT-proBNP对冠心病的预测价值,采用改良Gensini法评价冠脉病变的严重程度并分析其与冠心病危险因素及NT-proBNP的关系.结果两组的基线资料中,年龄、男性、吸烟史、糖尿病、高血压、血脂异常、家族史、LVEF、NT-proBNP差异均有统计学意义(P均＜0.01).单因素logistic回归分析,年龄、男性、吸烟史、糖尿病、高血压、血脂异常、家族史、NT-proBNP均为冠心病的危险因素(P均＜0.05).经ROC曲线分析,NT-proBNP界值为641.15.多因素logistic回归分析,除年龄、男性、糖尿病与冠心病独立相关外(P均＜0.01),NT-proBNP也是冠心病的独立预测因素(OR＝1.66,95%CI:1.06～2.61,P＜0.05),且年龄、血脂异常、NT-proBNP与冠脉病变严重程度相关(P均＜0.05).进一步的NT-proBNP与改良Gensini评分的相关性分析,NT-proBNP与改良Gensini评分呈正相关(r＝0.14,P＜0.01).多因素logistic回归分析,NT-proBNP不是改良Gensini评分的独立预测因素(P＞0.05).结论传统冠心病危险因素中年龄、男性、糖尿病与冠心病独立相关.NT-proBNP也是冠心病的独立预测因素,其水平的升高对冠心病及冠脉病变严重程度可能有一定临床预测价值.

The predictive role of N-terminal pro-brain natriuretic peptide in coronary heart disease

Objective To investigate whether N-terminal pro-brain natriuretic peptide （NT-proBNP） could be used as a predictor of coronary heart disease （CHD）. Methods A total of 658 consecutively admitted patients were analyzed. All patients had received coronary angiography and then were divided into two groups based on the results of coronary angiography （CHD group： n=484, and control group： n=174）. The clinical information including classical CHD risk factors, NT-proBNP, and left ventricle ejection fraction （LVEF） were analyzed to identify their relationships to CHD. The severity of CHD was evaluated by modified Gensini score, and its relationship with CHD risk factors and NT-proBNP was also analyzed. Results Among baseline characteristics of the two groups, patients with CHD were older, more often male and more likely to have smoking history, diabetes mellitus, hypertension, dyslipidemia, family history, decreased LVEF, and elevated NT-proBNP（all P〈0.01 ）. In univariate Logistic regression analysis, age, male gender, smoking history, diabetes mellitus, hypertension, dyslipidemia, family history, and NT-proBNP were risk factors to CHD（all P〈0.05）. In a receiver operating characteristic（ROC ） curve analysis, an NT-proBNP value of 641.15 was identified as an effective cut-point in the segregation of the presence or absence of CHD. Further, the correlation analysis between NT-proBNP and modified Gensini score was a significantly positive （r=0.37, P〈O.O01 ）. In multivariate Logistic regression analysis, besides age,the male gender, diabetes mellitus were independently related to CHD（all P〈0.01 ）, and NT-proBNP was also observed to be an independent predictor for angiographic CHD （0R=1.66, 95%CI： 1.06-2.61, P〈0.05）. In ad- dition, age, dyslipidemia and NT-proBNP were associated with the severity of coronary stenosis （all P〈0.05）, however, NT-proBNP was not observed to be an independent predictor for a modified Gensini score （P〉0.05）. Conclusion Male gender, diabetes mellitus were independently associated with CHD, and NT-proBNP was also observed to be an independent predictor for angiographic CHD, it could predict CHD and the severity of coronary stenosis.