NSTEMI患者GRACE评分与cTnI、BNP、GA水平相关性及其预测价值

［摘要］目的探究非ST段抬高性心肌梗死（non ST segment elevation myocardial infarction，NSTEMI）患者全球急性冠状动脉事件注册（global registry of acute coronary events，GRACE）评分与心肌肌钙蛋白I（cardiac troponin I，cTnI）、脑利钠肽（brain natriuretic peptide，BNP）、糖化血清白蛋白（glycated albumin，GA）水平相关性及其预测价值。方法选取NSTEMI患者153例作为研究对象，根据 GRACE评分分为3组，高危组（49例）GRACE评分＞140分，中危组（58例）GRACE评分109～140 分，低危组（46例）GRACE评分≤108分。检测各组患者cTnI、BNP、GA水平，术后6个月随访主要心血管事件（major adverse cardiac event，MACE）发生情况，并采用受试者工作特征曲线（receiver operating characteristic，ROC）分析GRACE评分、cTnI、BNP、GA水平对MACE的预测价值。结果不同GRACE危险分级患者cTnI、BNP、GA水平比较差异有统计学意义（P＜0.01）；高危组、中危组cTnI、BNP、GA水平高于低危组，而高危组cTnI、BNP、GA水平又高于中危组（P＜0.05）。GRACE评分与cTnI、BNP、GA水平呈显著正相关（P＜0.05）。术后6个月内高危组发生MACE 12例，中危组发生MACE 5例，低危组MACE 1例（P＜0.05）。12例ROC曲线分析结果显示，GRACE评分、cTnI、BNP、GA水平对MACE预测结果的AUC分别为0.761、0.674、0.662、0.669；Cut-off值分别为151.00分、3.83 mg/L、340.72 μg/L、20.01%；敏感度分别为66.70%、94.40%、77.80%、50.00%，特异度分别为74.10%、45.20%、54.10%、81.50%，Youden指数分别为0.408、0.396、0.374、0.318。结论NSTEMI患者GRACE评分与cTnI、BNP、GA水平呈显著正相关，且均对MACE有预测价值及其预测价值，其中GRACE评分的预测价值相对较高。

Correlation of GRACE score with cTnI,BNP and GA levels in NSTEMI patients and its predictive value

［Abstract］ Objective〖HTSS〗To explore the correlation and predictive value of global acute coronary event registration(GRACE) score with cardiac troponin I(cTnI), brain natriuretic peptide(BNP) and glycosylated serum albumin(GA) levels in patients with non ST elevation myocardial infarction(NSTEMI). 〖WTHZ〗Methods〖HTSS〗A total of 153 NSTEMI patients admitted were selected as research objects. According to grace score, subjects were divided into three groups: high risk group(49 cases) Grace score >140, medium risk group(58 cases) Grace score 109-140, low risk group(46 cases) Grace score ≤108. The levels of cTnI, BNP and GA were measured in each group, and the occurrence of mace was followed up for 6 months. The predictive value of grace score, cTnI, BNP and GA levels to mace was analyzed by ROC. 〖WTHZ〗Results〖HTSS〗Single factor analysis of variance showed that the levels of cTnI, BNP and GA in patients with different grace risk grades were statistically significant(P＜0.01); the levels of cTnI, BNP and GA in high-risk group and middle-risk group were higher than those in low-risk group, while the levels of cTnI, BNP and GA in high-risk group were higher than those in middle-risk group, and the differences were statistically significant(P＜0.05). Grace score was positively correlated with cTnI, BNP and GA(P＜0.05). There were 12 cases of MACE in the high-risk group within 6 months after operation,5 cases in the middle-risk group and 1 case in the low-risk group, the difference was statistically significant(P＜0.05). The results of ROC curve analysis of 12 cases showed that AUC of grace score, cTnI, BNP and GA were 0.761, 0.674, 0.662 and 0.669 respectively, cut off value was 151.00, 3.83 mg/L, 340.72 μg/L and 20.01 respectively, sensitivity was 66.70%, 94.40%, 77.80% and 50.00%, specificity was 74.10%, 45.20%, 54.10% and 81.50%, Youden index was 0.408, 0.396, 0.374， 0.318, respectively. 〖WTHZ〗Conclusion〖HTSS〗Grace score is positively correlated with cTnI, BNP and GA levels in NSTEMI patients, and has predictive value and predictive value for mace, among which grace score had the highest predictive value.