文章摘要
张明扬,赵艳军.NT-proBNP和左心室射血分数对急性心肌梗死 危险程度的早期评估[J].中国医药导刊,2017,19(10):997-1001.
NT-proBNP和左心室射血分数对急性心肌梗死 危险程度的早期评估
Assessment of The Early Death Risk of Acute Myocardial Infarction by NT-proBNP and LVEF
投稿时间:2017-09-06  修订日期:2017-09-06
DOI:
中文关键词: N末端脑钠肽原  左心室射血分数  急性心肌梗死  评估价值
英文关键词: NT-proBNP  LVEF  AMI  Prognosis assessment
基金项目:承德市科学技术研究与发展计划项目(项目编号:201701A071;项目名称:床旁快速检测BNP、D-dimer和LVEF对急性心肌梗死患者的早期风险评估价值)
作者单位E-mail
张明扬 河北省围场满族蒙古族自治县医院重症医学科 54752403@qq.com 
赵艳军 承德医学院附属医院 nobody50@163.com 
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中文摘要:
      目的: 通过检测N-末端脑钠肽原(NT-proBNP)和左心室射血分数(LVEF),早期评估急性心肌梗死(AMI)患者病情的危险程度。方法:收集2015年1月至2016年7月经急诊确诊的248例AMI患者的临床资料,依据患者28 d内是否死亡分为生存组和死亡组,生存组220例,男157例,女63例;死亡组28例,男21例,女7例。记录两组年龄、性别、是否表现为胸痛、院前时间、心电图、是否接受PCI、是否出现早期心脏不良事件、是否28 d内死亡;记录心肌损伤标志物(cTnI)、NT-proBNP、LVEF等,进行Logistic回归分析,绘制工作者曲线(ROC曲线),建立Cox回归模型,分析LVEF和NT-proBNP对AMI 28 d死亡的预测价值。 结果:分别比较28 d生存与死亡的患者,生存组的年龄、D-dimer和NT-proBNP均显著低于死亡组 [(68.0±11.6) 岁vs (73.5±7.6) 岁,P=0.002;(213.5±359.4) ng·mL-1 vs (685.7±624.9) ng·mL-1, P=0.000;(1796.4±3863.8) ng·mL-1 vs (6325.0±9951.8) ng·mL-1, P=0.002],而两组间院前时间、cTnI和LVEF无显著性差异,生存组的典型胸痛主诉和ST段抬高心电图改变的发生率均显著高于死亡组;将NT-proBNP与LVEF带入相关性方程,发现二者间存在负线性相关(P=0.000,B=-0.001);单独将年龄、D-dimer、NT-proBNP、LVEF和院前时间带入Logistic方程,结果提示年龄(P=0.023,B=0.141)与患者28 d死亡正相关,其他各项均无显著差异,然而将NT-proBNP与LVEF按生存可能性进行拟合,将拟合后结果带入Logistic方程,结果提示其二者联合与患者28 d死亡率正相关(P=0.000,B=6.49),而绘制ROC曲线提示,两个因素联合对28 d死亡率预测的曲线下面积为0.918。结论:检测NT-proBNP和LVEF可评估AMI的早期危险程度。
英文摘要:
      Objective: To investigate whether detection of N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) could be an early death risk assessment for patients with AMI.Methods:248 cases of AMI were collected from January 2015 to July 2016 through emergency department and were divided into survival group and death group according to the survival within the first 28 days.220 cases in the survival group (157 male, 63 female) and 28 cases in the death group (21 male,7 female).Clinical data like age,gender,chief complaint of chest pain, prehospital time,electrocardiogram(ECG) before treatment,whether received percutaneous coronary intervention(PCI) and appeared early adverse cardiac events or not,survival within 28 days, cardiac troponin I(cTnI), NT-proBNP,LVEF,etc were recorded.Logistic regression analysis,ROC curve and Cox regression model were utilized to analyze the predictive value of LVEF and NT-pro BNP for early death of AMI.Results:Compared with the death group,age,levels of D-dimer and NT-proBNP were lower in the survival group[(68.0±11.6)y vs (73.5±7.6)y,P=0.002; (213.5±359.4)ng·mL-1 vs (685.7±624.9)ng·mL-1, P=0.000; (1796.4±3863.8) ng·mL-1 vs (6325.0±9951.8) ng·mL-1,P=0.002],while no significant difference was observed in prehospital time,cTnI and LVEF.The incidence of typical chest pain complaint and ST-segment elevation of ECG in the survival group was significantly higher than that in the death group. Multivariate logistic regression analysis showed that LVEF values was negative correlated with LVEF(B=-0.001,P=0.000). Although only age was positive correlated with 28 d death (B=0.141,P=0.023).The combination of LVEF and NT-proBNP was positive correlated with 28 d death (B=6.49,P=0.000).The ROC curves showed that the area under the curve of 28 d mortality from the combination of two factors was 0.918.Conclusion: Assessments of LVEF and NT-proBNP are correlated with the early death risk of patients with AMI.
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