NT-脑钠肽前体在急性冠状动脉综合征早期风险分层中的价值。

The value of NT-proBNP in early risk stratification of acute coronary syndromes.

作者信息

Almeida Rui, Mariano Luís, Gavina Cristina, Pinho Teresa, Vasconcelos Mariana, Ferreira António, Maciel M Júlia, Gonçalves F Rocha

机构信息

Department of Cardiology, Hospital de São João, Porto, Portugal.

出版信息

Rev Port Cardiol. 2006 Jan;25(1):71-5.

PMID:16623357

Abstract

INTRODUCTION

The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. Its role in risk stratification in patients with acute coronary syndromes (ACS) is still under evaluation.

OBJECTIVE

We aimed to evaluate the prognostic value of NT-proBNP measured in the first 48 hours after admission due to an acute coronary syndrome.

METHODS

Our study included 142 patients (aged 62.7 +/- 12.0 years, 70.4% males) admitted to a cardiology unit with an ACS. All laboratory evaluations were performed in the first 48 hours after admission. The mean follow-up was 200 days. Death from any cause or hospitalization because of a major acute cardiovascular event (whichever occurred first) was defined as the end-point.

RESULTS

Cardiovascular risk factors were found in a significant proportion of our sample (hypertension in 56.3%, diabetes mellitus in 38.0%, current or previous smoking in 51.4%, dyslipidemia in 67.6%). Fifty-eight patients had left ventricular systolic dysfunction (LVSD). Serum levels of NT-proBNP were 2174 +/- 4801 pg/ml. Variables associated with event-free survival in univariate analysis were: NT-proBNP (HR 1.007, 95% CI 1.003-1.011, for each 100 pg/ml increment), serum glucose (hazard ratio [HR] 1.007, 95% CI 1.001-1.012, for each 1 mg/dl increment) and maximum cardiac troponin I (cTnI) level (HR 1.005, 95% CI 1.001-1.009, for each 1 ng/ml increment). The white blood count (WBC) was marginally associated with a poor prognosis (HR 1.152, 95% CI 0.994-1.335, for each 1000/mm3 increment). After adjustment for the above variables, age, sex, left ventricular systolic dysfunction, diabetes, coronary anatomy and coronary revascularization using a forward likelihood ratio Cox regression model, NT-proBNP remained the only variable with significant prognostic value (HR 1.007, 95% CI 1.003-1.011, for each 100 pg/ml increment).

CONCLUSIONS

These data suggest that NT-proBNP is a strong clinical predictor of prognosis in acute coronary syndromes. Its early measurement should be included in the risk stratification strategy in this setting.

摘要

引言

脑钠肽（NT-proBNP）的N端部分已被确定为不同心血管疾病预后的一个指标。其在急性冠脉综合征（ACS）患者风险分层中的作用仍在评估中。

目的

我们旨在评估因急性冠脉综合征入院后48小时内检测的NT-proBNP的预后价值。

方法

我们的研究纳入了142例因ACS入住心内科的患者（年龄62.7±12.0岁，男性占70.4%）。所有实验室评估均在入院后48小时内进行。平均随访时间为200天。任何原因导致的死亡或因重大急性心血管事件住院（以先发生者为准）被定义为终点。

结果

我们的样本中有很大比例存在心血管危险因素（高血压占56.3%，糖尿病占38.0%，当前或既往吸烟占51.4%，血脂异常占67.6%）。58例患者存在左心室收缩功能障碍（LVSD）。NT-proBNP的血清水平为2174±4801 pg/ml。单因素分析中与无事件生存相关的变量有：NT-proBNP（每增加100 pg/ml，HR 1.007，95%CI 1.003 - 1.011）、血糖（每增加1 mg/dl，风险比[HR] 1.007，95%CI 1.001 - 1.012）和心肌肌钙蛋白I（cTnI）最高水平（每增加1 ng/ml，HR 1.005，95%CI 1.001 - 1.009）。白细胞计数（WBC）与预后不良有微弱关联（每增加1000/mm³，HR 1.152，95%CI 0.994 - 1.335）。在使用向前似然比Cox回归模型对上述变量、年龄、性别、左心室收缩功能障碍、糖尿病、冠状动脉解剖结构和冠状动脉血运重建进行校正后，NT-proBNP仍然是唯一具有显著预后价值的变量（每增加100 pg/ml，HR 1.007，95%CI 1.003 - 1.011）。