目的：探讨N末端脑钠肽前体（ NT-proBNP）对急性ST段抬高型心肌梗死（ STEAMI）患者经皮冠状动脉介入（PCI）术后1年内心血管事件的预测价值。方法选择直接PCI治疗的STEAMI患者126例，测定NT-proB-NP水平、肌酸激酶同工酶、心肌肌钙蛋白I（cTnI），记录1年内心血管事件的发生情况，根据有无心血管事件分为事件组（38例）和非事件组（88例）。结果事件组年龄、NT-proBNP、Gensini积分、三支病变构成比、糖尿病构成比明显高于非事件组（ P ＜0Ö．05）；入院后48 h内NT-proBNP水平预测心血管事件阈值定为870 pg／ml时，其敏感度为78．9％（30／38），特异度为70．5％（62／88），阳性预测值为53．6％（30／56），阴性预测值为88．6％（62／70），准确率为73．0％（92／126）。以870 pg／ml为分界点将患者分为高NT-proBNP组（56例）和低NT-proBNP组（70例），2组心血管事件发生率分别为53．6％（30／56）和11．4％（8／70），差异有统计学意义（ P ＜0．01）。高NT-proBNP组的冠状动脉近段病变、三支病变构成比均较低NT-proBNP组高（46．4％vs．17．2％，32．1％vs．12．9％， P ＜0．01），Gensini积分亦明显高于低NT-proBNP组[（78．4±13．7）分vs．（45．3±11．3）分， P ＜0．01]。运用Logistic回归分析，只有年龄、NT-proBNP、糖尿病、Gensini积分是1年内发生心血管事件的独立预测因子。结论 NT-proBNP对预测STEAMI患者1年内的心血管事件具有重要价值。%Objective To investigate the prognostic value of N-terminal pro brain natriuretic peptide ( NT-proBNP) on 1 year cardiovascular events in acute ST segment elevation myocardial infarction ( STEAMI) patients with PCI after opera-tion.Methods One hundred and twenty-six patients with STEAMI and treated with PCI were enrolled , the level of NT-proB-NP, creatine kinase isoenzymes , cardiac troponin I were measured , the occurrence of 1 years cardiovascular events were recor-ded, according to the heart vascular events , patients were divided into event group (38 cases) and nonevent group (88 ca-ses).Results In event group, age, NT-proBNP, Gensini integral, three vessel disease constituent ratio , diabetes constituent ratio is significantly higher than that of nonevent group ( P <0.05);admission within 48 h, the threshold of NT-proBNP lev-els to predict cardiovascular events is 870 pg/ml with sensitivity of 78.9% (30/38), the specificity was 70.5% (62/88), the positive predictive value was 53.6%(30/56) and the negative predictive value was 88.6%(62/70), the accuracy rate was 73.0%(92/126).With 870 pg/ml as the cutoff points, patients were divided into high NT-proBNP group (56 cases) and low NT-proBNP group (70 cases), 2 groups of cardiovascular event rates were 53.6% (30/56) and 11.4% (8/70), the difference was statistically significant ( P <0.01).The proximal segment of coronary artery lesion and constituent ratio of three vessel lesion in high NT-proBNP group were lower than in NT-proBNP group (46.4%vs.17.2%, 32.1%vs.12.9%, P <0.01), the Gensini score in high NT-proBNP group was also significantly higher than the low NT-proBNP group [(78.4 ± 13.7) vs.(45.3 ±11.3), P <0.01].Using Logistic regression analysis , only age, NT-proBNP, diabetes, Gensini score are independent predictors of 1 year cardiovascular events .Conclusion NT-proBNP have important value in prediction of 1 year cardiovascular events in STEAMI patients .
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