急性冠脉综合征TIMI风险积分与脑钠尿肽及临床预后的关系

目的探讨TIM I风险积分对介入治疗后急性冠脉综合征（ACS）患者短期预后的预测作用及比较不同积分组血浆脑钠尿肽（BNP）水平。方法连续入选2004年11月至2005年4月因ST段抬高的心肌梗死（STEM I）在我院行经皮冠状动脉介入（PC I）治疗者75例,因不稳定型心绞痛（UAP）/非ST段抬高的心肌梗死（NSTEM I）在我院行PC I治疗者47例,入院时对入选患者进行心肌梗死溶栓试验（TIM I）风险积分。采用荧光免疫方法测定血浆BNP水平。结果在STEM I患者组,根据TIM I风险积分分为04分,59分,1014分3组。随着TIM I风险积分升高,各组病死率呈明显递增趋势。在多变量的Logistic回归分析中,TIM I风险积分能够独立预测住院期间、1个月和3个月病死率及住院期间、1个月主要心血管不良事件（MACE）发生率（均P<0.01）。不同的TIM I风险积分各组间血浆BNP水平有显著性差异（P<0.01）。在多元回归分析中,TIM I风险积分分组不受年龄、性别、家族史、吸烟、高胆固醇血症、高血压、糖尿病等因素的影响,而与血浆BNP水平呈独立正相关（r=0.52,P<0.01）。在UAP/NSTEM I患者组,根据TIM I风险积分分为02分,35分,57分3组。随着TIM I风险积分升高,各组病死率呈明显递增趋势。在多变量的Logistic回归分析中,TIM I风险积分能够独立预测3个月病死率及1个月和3个月MACE发生率（均P<0.01）。各组间血浆BNP水平有显著性差异（P<0.01）。在多元回归分析中,TIM I风险积分分组经年龄、性别、高胆固醇血症因素校正后与血浆BNP水平呈正相关（r=0.41,P<0.01）。结论TIM I风险积分能够较好地对ACS患者进行危险分层,预测短期病死率和MACE发生率。ACS患者按TIM I风险积分递增分组与血浆BNP水平呈正相关。TIM I风险积分越高组血浆BNP水平越高。

Relation of TIMI risk score with plasma brain natriuretic peptide level and clinical prognosis in patients with acute coronary syndrome

AIM To evaluate the value of TIMI risk scores in estimating risk stratification in patients with acute coronary syndromes(ACS) and to determine the relationship between TIMI risk scores and plasma BNP level in ACS.METHODS The study population consisted of 123 consecutive patients with ACS who had undergone PCI(include 75 patients with STEMI and 47 patients with UAP/NSTMI).The TIMI risk score was calculated on admission and plasma BNP was measured by fluoroimmunoassay.(RESULTS) The TIMI risk scores for STEMI patients were calculated and were divided into 3 groups(TIMI scores 0 to 4,5 to 9 and 10 to 14).The higher the TIMI risk scores on admission,the worse the prognosis.The TIMI risk score was an independent predictor of in-hospital,1-month and 3-month mortality as well as in-hospital,30 day incidence of MACE(P<0.01).The score could also predict 3 month(P<0.01) incidence of MACE if adjusted by hypercholesterolemia(P=0.0390).The plasma BNP level of these 3 groups was significantly different(P<0.01).In the multivariate model,the TIMI risk score was positively correlated with the plasma BNP level(r=0.52,P<0.01),independent of other known prognostic factors(included patient age,gender,family heredity,hypercholesterolemia,diabetes,hypertension and smoking).The TIMI risk scores for UAP/NSTEMI patients were calculated and they were divided into 3 groups(TIMI scores 0 to 2,3 to 5and 6 to 7).The TIMI risk score was an independent predictor of 3-month mortality and 1-month and 3-month incidence of MACE(P<0.01).The plasma BNP level of these 3 groups was significantly different(P<0.01).In the multivariate model,the TIMI risk score was positively correlated with the plasma BNP level(r=0.41,P<0.01).(CONCLUSION) This TIMI risk scoring system is a simple and practical tool at the bedside in quantitative risk evaluation and short-term prognosis prediction in patients with ACS.The TIMI risk score is positively correlated with the plasma BNP level.