NT-proBNP、Tei指数联合GRACE评分预测急诊PCI患者短期预后的价值

摘要

目的：探讨NT-proBNP、Tei指数联合GRACE评分对急诊经皮冠脉介入(PCI)患者短期预后的预测价值。方法入选147例急性心肌梗死(AMI)并接受急诊PCI患者为研究对象，观察记录所有患者的NT-proB-NP、Tei指数和GRACE评分水平，并随访PCI术后30 d的主要不良心脏事件(MACE)。对比分析发生MACE事件(n=34)和没有发生MACE (n=113)事件患者各项指标的差异。结果 MACE组患者的GRACE评分、NT-proBNP水平和Tei指数均显著高于非MACE组(P<0.05)。相关分析结果显示，Tei指数和NT-proBNP水平以及GRACE评分均呈正相关(r=0.819，P<0.05；r=0.797，P<0.05)；NT-proBNP水平和GRACE评分亦呈正相关(r=0.658, P<0.05)。多变量Logistic回归分析显示，心衰病史(P=0.009，OR=1.401，95%CI：1.076~5.814)，NT-proBNP>1000 ng/ml (P=0.010， OR=1.742，95%CI：1.076~9.822)，Tei指数>0.60(P=0.015，OR=1.826，95%CI：1.141~4.023)，GRACE评分>140(P=0.004，OR=2.140，95%CI：1.274~11.752)是MACE事件的独立危险因素。结论 NT-proBNP、Tei指数联合GRACE评分能更全面准确地评估急诊PCI术后的短期预后。%Objective To investigate the predictive value of NT-proBNP, Tei index and GRACE score in short-term prognosis of patients undergoing primary percutaneous coronary intervention (PCI). Methods A total of 147 patients with acute myocardial infarction (AMI) undergoing primary PCI were enrolled in the study. The levels of NT-proBNP, Tei index and GRACE score after primary PCI were recorded. The patients were divided into MACE group (n=34) and non-MACE group (n=113), according to whether MACE were documented during 30-day follow up. NT-proBNP, Tei index and GRACE score were compared between the two groups. Results Levels of NT-proB-NP, Tei index and GRACE score in MACE group were significantly higher than those in non-MACE group (P<0.05). Correlation analysis indicated that Tei index was positively correlated with NT-proBNP and GRACE score (r=0.819, P<0.05;r=0.797, P<0.05). GRACE score was also positively correlated with NT-proBNP (r=0.658, P<0.05). Multivariate logistic regression analysis showed that heart failure (P=0.009, OR=1.401, 95% CI 1.076~5.814), NT-proBNP>1 000 ng/ml (P=0.010, OR=1.742, 95% CI 1.076~9.822), Tei index>0.60 (P=0.015,OR=1.826,95%CI 1.141~4.023), GRACE score>140 (P=0.004, OR=2.140, 95%CI 1.274~11.752) were the independent risk factors of MACE. Conclusion Integrated application of NT-proBNP, Tei index and GRACE score may be more accurate in predictive evaluation of the short-term prognosis after primary PCI.