GRACE风险评分联合B型利钠肽对急性冠脉综合征近期死亡风险的预测价值

摘要

Objective To determine whether B-type natriuretic peptide levels and GRACE risk scores can predict early mortality in the patients with acute coronary syndrome(ACS).Methods 318 patients with ACS were studied.Blood was drawn within 24 h after the onset of chest pain and the plasma concentration of BNP was determined and the patients ＇ GRACE risk score was measured.To observe the effect of early mortality by BNP levels and GRACE risk score.Results The mortality was 13.5％ (n= 43) and was related to higher GRACF risk scores(P＜0.001).Higher BNP levels were also related to mortality in the first 24 h(BNP,2.286[95％CI,1.425-3.667] ,P=0.001; and GRACE risk scores ( 1.007 [95％ CI, 1.003 - 1.011] , P = 0.001).BNP yielded an mortality.In a multivariate Cox proportional hazards model,independent predictors of BNP and GRACE risk scores,area under the curve( AUC) of 0.886 (P＜0.001), for TIMI risk score the AUC was 0.858(P＜0.001) , for the AUC of combination of TIMI score and BNP was 0.937(P＜0.001).The receiveroperating curve for the GRACE risk score was compiemented by BNP levels for prediction of 30 d mortality [AUC( area under the curve) , 0.937 (0.889 - 0.986) ].Conclusion In the first 24 h following anACS, BNP is better than the GRACE risk score at predicting early mortality.The combination of GRACE score and BNP can improve risk prediction for early mortality.%目的 评价全球急性冠状动脉事件注册(GRACE)风险评分联合B型利钠肽(BNP)对急性冠脉综合征(ACS)患者近期病死率的影响.方法 318例ACS患者测定血浆BNP水平及接受标准GRACE风险评分评定.随访观察入院时血浆BNP和GRACE风险评分对其近期病死率的影响.结果 318例患者近期病死率与高GRACE危险积分相关(P<0.001).与存活者相比,死亡者GRACE风险总积分最高,且血浆BNP水平亦明显升高.Cox模型分析表明,血浆BNP水平升高和GRACE危险积分均为预测其近期死亡风险升高的独立可靠指标.Kapian-Meier生存曲线分析进一步提示,BNP低于中位数者较高于中位数者近期预后明显较佳(P＜0.001).GRACE风险评价低危组较中、高危组近期预后明显较佳(P<0.01).近期生存曲线下面积(AUC)BNP为0.886(P<0.001),GRACE危险积分为0.858(P<0.001),而联合BNP水平与GRACE危险积分两者进行综合评定时,AUC为0.937(P<0.001).结论 ACS发病24 h内早期测定BNP水平联合GRACE危险积分评定可提高其对ACS的预测价值.