氨基末端B型利钠肽前体检测对急性Stanford A型主动脉夹层患者预后评估的临床意义

摘要

目的：探讨氨基末端B型利钠肽前体（NT-proBNP）检测对急性Stanford A型主动脉夹层（AAAD）预后评估的临床意义。方法回顾性分析确诊为AAAD的患者病历资料，根据纳入及排除标准，64例患者纳入研究，根据预后将其分为存活组（n＝56）和死亡组（n＝8）。应用多因素Logistic逐步回归分析，筛查出影响预后的独立危险因素；使用受试者工作特征（ROC）曲线评价NT-proBNP预测AAAD预后的价值。结果存活组与死亡组患者吸烟史、发病季节、意识障碍、误诊、低密度脂蛋白胆固醇（LDL-C）、空腹C肽（FCP）、超敏C反应蛋白（hs-CRP）、心肌肌钙蛋白I（cTnI）、NT-proBNP、平均动脉压（MAP）及凝血酶原时间（PT）的差异具有统计学意义（P＜0．05）。多因素Logistic逐步回归分析显示，吸烟史、意识障碍、高LDL-C、高cTnI、高 NT-proBNP、低MAP是患者不良预后的独立危险因素。NT-proBNP预测AAAD患者围手术期死亡风险的ROC曲线下面积（AUC）为0．697（P＜0．05，95％ CI：0．643～0．733）；其特异性、敏感性分别为75．85％、70．07％；NT-proBNP取909．69 pg/mL时，AAAD预测价值最佳，以该临界值为界，将患者分为临界值以上组和临界值以下组，则临界值以下组患者围手术期存活率[98．18％（54/55）]显著高于临界值以上组[22．22％（2/9）]（χ2＝7．211，P＜0．05）。结论 NT-proBNP水平与 AAAD患者的预后密切相关， NT-proBNP检测有助于AAAD高危风险的评估。%Objective To investigate the clinical significance of N-terminal pro-B-type natriuretic peptide(NT-proBNP) detection in evaluation of acute type A aortic dissection (AAAD) prognosis .Methods Medical records of patients with confirmed diagnosis of AAAD were retrospectively analyzed .64 patients were enrolled in accordance with the inclusion and exclusion criteria ,and were di-vided into survival group(n=56) and death group(n=8) according to prognosis .Multivariate Logistic regression analysis was em-ployed to screen the independent risk factors which would affected the prognosis .Receiver operator characteristic ,ROC) curve was used to evaluate the predictive value of NT-proBNP for AAAD prognosis .Results Differences of history of smoking ,incidence sea-son ,disturbance of consciousness ,misdiagnosis ,low density lipid-cholesterol(LDL-C) ,fasting C-peptide(FCP) ,hypersensitive C-re-active protein(hs-CRP) ,cardiac troponin I(cTnI) ,NT-proBNP ,mean arterial pressure(MAP) and prothrombin time(PT) of pa-tients between the survival group and the death group showed statistical significance (P<0 .05) .Multivariate Logistic regression a-nalysis demonstrated that smoking history ,disturbance of consciousness ,high LDL-C ,high cTnI ,high NT-proBNP and low MAP were independent risk factors for patients with poor prognosis .ROC area under the curve(AUC) of NT-proBNP prediction for peri-operative mortality risk of patients with AAAD was 0 .697(P< 0 .05 ,95% CI:0 .643~0 .733) ,and its specificity and sensitivity were 75 .85% and 70 .07% ,respectively .When NT-proBNP was 909 .69 pg/mL ,its predictive value for AAAD was the best .Set the critical value as the threshold ,the patients above were divided into the threshold above group and the threshold below group . The survival rate of patients in the threshold below group [98 .18% (54/55)] was significantly higher than that in the threshold a-bove group[22 .22% (2/9)](χ2 = 7 .211 ,P< 0 .05) .Conclusion NT-proBNP level is closely related to the prognosis of patients with AAAD and NT-proBNP detection may be conducive to predicting high risk of AAAD .