摘要
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。
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 GRACE risk scores（P0.001）.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（P0.001）,for TIMI risk score the AUC was 0.858（P0.001）,for the AUC of combination of TIMI score and BNP was 0.937（P0.001）.The receiver-operating curve for the GRACE risk score was complemented by BNP levels for prediction of 30 d mortality.Conclusion In the first 24 h following an ACS,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.
出处
《重庆医学》
CAS
CSCD
北大核心
2011年第14期1424-1426,共3页
Chongqing medicine
