NT-proBNP对老年稳定型冠心病患者未来不良心脏事件风险评估价值

摘要

目的 探讨氨基末端B型钠尿肽原(NT-proBNP)对老年稳定型冠心病(SCAD)患者未来主要不良心脏事件(MACE)风险评估的价值.方法 将810例老年SCAD患者按随访期内病情转归情况分为非MACE组468例、MACE组342例(包括心源性再入院组200例、非致死急性心肌梗死(AMI)组61例、死亡组81例)；按MACE发生时间顺序分为近期MACE组180例和远期MACE组162例.采用双向侧流免疫法检测所有入选患者和40名健康对照者以及入选患者随访期间的第3个月、第6个月及第12个月血清NT-proBNP水平,并进行统计学分析.对患者平均随访24个月,观察随访期间发生的MACE.结果 初次住院时,MACE组及非MACE组NT-proBNP水平明显高于对照组(P＜0.01)；MACE组NT-proBNP水平高于非MACE组(P＜0.01),近期MACE组高于远期MACE组(P＜0.05)；死亡组及非致死AMI组NT-proBNP水平明显高于再入院组(P＜0.05).且NT-proBNP水平与患者再入院和发生AMI的时间呈负相关[r值分别为-0.359(P =0.00)、-0.458(P=0.026)].随着NT-proBNP水平的增高,不同NT-proBNP水平组的MACE发生率相应增高,除NT-proBNP＞6 000 ng/L组外,其余各组MACE发生率差异有统计学意义(P＜0.01).MACE组发生MACE前的NT-proBNP峰值水平明显高于非MACE组.死亡组NT-proBNP峰值水平明显高于其他组(P＜0.05、P＜0.01).在随访第3个月、第6个月及第12个月,MACE组NT-proBNP水平均高于初次进院时(P＜0.01)；非MACE组患者NT-proBNP水平明显低于初次进院时(P＜0.01),亦明显低于MACE组(P＜0.01).Kaplan-Meier曲线分析表明,不同NT-proBNP水平组患者的生存率差异有统计学意义(P＜0.01).合并不同疾病死亡组患者血清NT-proBNP水平比较差异无统计学意义(P＞0.05).结论 老年SCAD患者未来MACE发生率及其发生时间与初入院时NT-proBNP水平、随访期内NT-proBNP动态变化及其峰值水平密切相关.NT-proBNP检测对老年SCAD未来MACE风险评估有较高的预测价值.%Objective To investigate the significance of serum N-terminal pro-B-type natriuretic peptide (NTproBNP) for the future risk evaluation of major adverse cardiac events (MACE) in elderly patients with stable coronary artery disease (SCAD).Methods A total of 810 elderly patients with SCAD were classified into non-MACE group (468 cases) and MACE group [342 cases,including cardiogenic readmission group (200 cases),nonfatal acute myocardial infarction (AMI) group (61 cases) and death group (81 cases)] according to disease prognosis.The 342cases of MACE group were classified into the short-term MACE group(180 cases)and the long-term MACE group (162cases).The serum NT-proBNP levels of 40 healthy controls and 810 elderly patients with SCAD,which were followed up in the third month,in the sixth month and in the twelfth month,were determined by bi-directional lateral flow immunoassay.The results were analyzed statistically.The MACE were followed up and observed for an average of 24 months.Results The serum NT-proBNP levels at initial admission in the MACE group and non-MACE group were significantly higher than those in the control group(P ＜ 0.01),the serum NT-proBNP levels at initial admission in the MACE group were significantly higher than those in the non-MACE group (P ＜0.01),the serum NT-proBNP levels at initial admission in the short-term MACE group were significantly higher than those in the long-term MACE group (P ＜0.05),and the serum NT-proBNP level at initial admission in the death group and nonfatal AMI group were significantly higher than those in the cardiogenic readmission group (P ＜ 0.05).The serum NT-proBNP levels at initial admission were negatively correlated with the intevaal time of the patients with readmission and AMI [r =-0.359 (P =0.000),r =-0.458 (P =0.026)].The serum NT-proBNP level was higher,and the incidence rates of MACE were higher.The incidence rates of MACE in different serum NT-proBNP level groups were significantly different (P ＜ 0.01),except the NT-proBNP ＞6 000 ng/L group.Before MACE,the top value of serum NT-proBNP in the MACE group was significantly higher than that in the non-MACE group,and the top value of serum NT-proBNP in the death group was significantly higher than that in the other groups (P ＜0.05,P ＜0.01).In the third,sixth and twelfth months of follow-up period,the serum NT-proBNP levels in thc MACE group were significantly higher than those at initial admission (P ＜ 0.01).The serum NT-proBNP levels in the non-MACE group were significantly lower than those at initial admission (P ＜0.01),and were significantly lower than those in MACE group (P ＜ 0.01).Kaplan-Meier curve showed that the survival rate with different serum NT-proBNP levels had statistical significance (P ＜ 0.01).The death group with various diseases had no statistical significance for the serum NT-proBNP levels (P ＞ 0.05).Conclusions The incidence rate of MACE and the interval time of the MACE in elderly patients with SCAD are closely correlated with the serum NT-proBNP level at initial admission and with the changes of serum NT-proBNP levels and the top value of serum NT-proBNP in the follow-up period.The serum NT-proBNP determination for the MACE risk evaluation in elderly patients with SCAD has an important prognostic significance.