血浆氨基末端脑钠肽前体对NSTEMI患者预后评估的价值

目的：探讨血浆N末端B型利钠肽原（NT-proBNP）评估非ST段抬高性心肌梗死（NsTEMI）患者预后的价值。方法：回顾性分析我院96例住院的NSTEMI患者的临床及随访资料，依据转归结局分为：无事件组（46例），未发生主要不良心血管事件（MAcE）。事件组（50例）：发生MACE。检测并比较两组患者住院期间NT—proBNP、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）水平以及左室舒张末期内径（LVEDd）、二尖瓣舒张早期／晚期的最大血流速度比（E／A）、左室射血分数（LVEF）。应用单因素直线分析及多元Logistic回归分析患者MACE发生率相关因素，应用ROC曲线分析NT-proBNP的最佳预测值。结果：与无事件组相比，事件组的NT—proBNP（3157．5±102．4）pmol／L比（4309．6±214．6）pmol／L]、LVEDd（58．1±5．5）mm比（74．3±6．8）mm]显著升高，LVEF（71．8±4．1）％比（49．5±3．9）％]、E／A比值（o．84±0．18）比（O．62±0．12）]明显降低（P均〈0．05），而TC、LDL-C水平无显著差异（P均〉0．05）。多元Logistic回归分析显示。NT—proBNP为MACE的独立预测因子（OR=1．003，P=0．009）。血浆NT—proBNP≤4390pmol／L者的生存率高于NT-proBNP〉4390pmol／L（0R=5．028，P=0．021）。结论：血浆N末端B型利钠肽原能独立预测非ST段抬高性心肌梗死患者的预后。

Prognostic value of NT-proBNP in patients with non ST elevation myocardial infarction

Objective： To explore the prognostic value of N-terminal pro brain natriuretic peptide （NT-proBNP） assessing prognosis in patients with non ST elevation myocardial infarction （NSTEMI）. Methods： Clinical and followup data of 96 NSTEMI inpatients from our hospital were retrospectively analyzed. According to their outcomes, they were divided into no event group In = 46, no major adverse cardiovascular events （MACE） occurred] and event group （n = 50, MACE occurred）. Levels of NT-proBNP, total cholesterol （TC） and low density lipoprotein choles- terol （LDL-C）, left ventricular end-diastolic diameter （LVEDd）, mitral early/late diastolic peak flow velocity （E/ A） and left ventricular eiection fraction （LVEF） were measured and compared between two groups. Single-factor linear analysis and multivariate Logistic regression analysis were used to analyze relative factors of MACE incidence rate, ROC curve was used to analyze the best predictive value of NT-proBNP. Results： Compared with no event group, there were significant rise in NT-proBNP level （3157.5± 102.4） pmol/L vs. （4309.6 ±214.6） pmol/L] and LVEDd （58.1 ± 5.5） mm vs. （74.3 ± 6.8） mm]; and significant reduction in LVEF （71.8 ± 4.1） % vs. （49.5 ± 3.9） %] and E/A （0.84 ± 0.18） vs. （0.62 ± 0.12）] in event group （P〈0.05 all）. There were no significant difference in TC and LDL-C levels between two groups （P〈0.05 both）. Multivariate Logistic regression analysis in- dicated that NT-proBNP was an independent predictor for MACE （OR = 1. 003, P = 0. 009）. Survival rate of those with plasma NT-proBNP≤4390 pmol/L was significantly higher than those with NT-proBNP〉4390 pmol/L （OR = 5. 028, P = 0. 021）. Conclusion： Plasma N-terminal pro brain natriuretic peptide can independently predict prognosis of patients with non ST elevation myocardial infarction.