血浆脑钠肽和C反应蛋白在接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者中的预后价值

[Prognostic value of plasma brain natriuretic peptide and C-reactive protein in patients with acute coronary syndromes underwent percutaneous coronary intervention].

作者信息

He Ben, Ding Song, Pu Jun, Liu Jian-ping, Song Wei, Du Yong-ping, Shen Jie-yan, Jin Shu-xuan, Sun Yu, Shen Long

机构信息

Department of Cardiology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Apr;34(4):349-52.

PMID:16776932

Abstract

OBJECTIVE

To evaluate the prognostic value of plasma brain natriuretic peptide (BNP) and C-reactive protein (CRP) in patients with acute coronary syndromes (ACS) underwent percutaneous coronary intervention (PCI).

METHODS

Patients with ACS underwent PCI in our hospital from December 2004 to September 2005 were included in this study. Plasma BNP (n = 189) and CRP (n = 141) were measured at a median of (34.2 +/- 16.3) hours from symptom onset, total mortality and the risk for major adverse cardiac events (MACE, including death, recurrent MI, recurrent angina, heart failure, readmission for any reason) at 30 days and at 3 months was analyzed.

RESULTS

Patients were divided into 4 groups according to their BNP levels (BNP <or= 100 ng/L, BNP > 100 ng/L to <or= 300 ng/L, BNP > 300 ng/L to <or= 600 ng/L and BNP > 600 ng/L) and the 3-month mortality was 0%, 1.4%, 7.7%, 48.3% and 3-month incidence of MACE was 7.9%, 17.1%, 57.7%, 79.3% respectively. Multivariate logistic regression analyses showed that the plasma BNP level predicted 30-day (r = 0.8515, P < 0.01) and 3-month (r = 0.9201, P < 0.01) mortality and 30-day (r = 0.7066, P < 0.01) and 3-month (r = 0.7090, P < 0.01) incidence of MACE independent of other known prognostic factors such as age, gender, family heredity, hypercholesterolemia diabetes, hypertension, smoking and LVEF. Patients were divided into 3 groups according to their CRP levels (CRP <or= 8.0 mg/L, CRP > 8.0 mg/L to <or= 32.0 mg/L, CRP > 32.0 mg/L) and 3-month mortality was 2.7%, 7.7% and 28.6% and 3-month incidence of MACE was 28.4%, 41.0% and 60.7% respectively. CRP predicted 30-day (r = 0.5882, P = 0.0044) and 3-month (r = 0.5235, P = 0.0038) mortality independent of traditional risk factors, and predicted 30-day (r = 0.2705, P = 0.0380) and 3-month (r = 0.2290, P = 0.0429) incidence of MACE after adjustment for patient age. CRP lost its predictive value after BNP was introduced into the model, while BNP was still an independent predictor for mortality and incidence of MACE at 30 days and 3 months in ACS patients underwent PCI.

CONCLUSION

Both plasma BNP and CRP are good predictors for early mortality and MACE incidence in ACS patients underwent PCI.

摘要

目的

评估血浆脑钠肽（BNP）和C反应蛋白（CRP）对接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者的预后价值。

方法

纳入2004年12月至2005年9月在我院接受PCI的ACS患者。在症状发作后中位时间（34.2±16.3）小时测定血浆BNP（n = 189）和CRP（n = 141），分析30天和3个月时的总死亡率以及主要不良心脏事件（MACE，包括死亡、再发心肌梗死、再发心绞痛、心力衰竭、因任何原因再次入院）风险。

结果

根据BNP水平将患者分为4组（BNP≤100 ng/L、BNP＞100 ng/L至≤300 ng/L、BNP＞300 ng/L至≤600 ng/L以及BNP＞600 ng/L），3个月死亡率分别为0%、1.4%、7.7%、48.3%，3个月MACE发生率分别为7.9%、17.1%、57.7%、79.3%。多因素逻辑回归分析显示，血浆BNP水平可独立于年龄、性别、家族遗传、高胆固醇血症、糖尿病、高血压、吸烟和左心室射血分数等其他已知预后因素预测30天（r = 0.8515，P＜0.01）和3个月（r = 0.9201，P＜0.01）死亡率以及30天（r = 0.7066，P＜0.01）和3个月（r = 0.7090，P＜0.01）MACE发生率。根据CRP水平将患者分为3组（CRP≤8.0 mg/L、CRP＞8.0 mg/L至≤32.0 mg/L、CRP＞32.0 mg/L），3个月死亡率分别为2.7%、7.7%、28.6%，3个月MACE发生率分别为28.4%、41.0%、60.7%。CRP可独立于传统危险因素预测30天（r = 0.5882，P = 0.0044）和3个月（r = 0.5235，P = 0.0038）死亡率，并在调整患者年龄后预测30天（r = 0.2705，P = 0.0380）和3个月（r = 0.2290，P = 0.0429）MACE发生率。将BNP引入模型后，CRP失去其预测价值，而BNP仍是接受PCI的ACS患者30天和3个月死亡率及MACE发生率的独立预测因子。