【摘要】 目的:研究住院期间血浆BNP水平动态变化对急性STEMI患者出院后发生CHF风险的预测价值。方法:根据发病24h到第5d内血浆BNP水平变化值,我院的236例急性STEMI患者被分为BNP动态变化组(116例,血浆BNP水平变化>82pg/dl)和BNP无动态变化组(120例,血浆BNP水平变化≤82pg/dl)。比较两组一般临床资料,随访1年,评定两组Kaplan-Meier生存曲线及全球急性冠状动脉事件注册(GRACE)评分,分析血浆BNP水平动态变化及上述两项联合检测对CHF的预测价值。结果:与BNP无动态变化组比较,BNP动态变化组甘油三酯水平[(137.0±59.0)mg/dl比(180.0±74.0)mg/dl]显著升高,发病后第5d血浆BNP水平[342.0(274.0, 434.8)pg/dl比120(98.0, 155.0)pg/dl]显著降低,P<0.05或<0.01。Kaplan-Meier生存曲线分析显示,BNP动态变化组随访1年内CHF发生风险显著高于BNP无动态变化组(P=0.017)。ROC曲线分析显示,GRACE评分、血浆BNP水平动态变化及二者联合检测预测CHF的敏感度分别为72.1%、67.6%、82.4%,特异性分别为64.9%、91.7%、69.0%,曲线下面积分别为0.705、0.820、0.847;血浆BNP水平、两项联合检测对CHF的预测价值均显著高于GRACE评分(P=0.043,0.001)。结论:住院期间血浆BNP水平动态变化联合GRACE评分对急性STEMI患者出院后1年内发生CHF具有一定预测价值。更多还原

【Abstract】 Objective:To study predictive value of dynamic change of plasma BNP level during hospitalization for CHF risk in acute STEMI patients after discharge. Methods:According to change value of plasma BNP level from 24 h to 5 th day after onset, a total of 236 acute STEMI patients treated in our hospital were divided into BNP dynamic change group(n=116, plasma BNP level change>82 pg/dl) and no BNP dynamic change group(n=120, plasma BNP level change ≤82 pg/dl). General clinical data were compared between two groups. Kaplan-Meier survival curve and predictive value of GRACE score, dynamic change of plasma BNP level and above stated dual detection for CHF after one-year follow-up were analyzed. Results: Compared with no BNP dynamic change group, there were significant rise in triglyceride level [(137.0± 59.0)mg/dl vs.(180.0±74.0)mg/dl], and significant reduction in plasma BNP level on 5 th day after onset [342.0(274.0, 434.8)pg/dl vs. 120(98.0, 155.0)pg/dl]in BNP dynamic change group, P<0.05 or<0.01. Kaplan-Meier survival curve analysis indicated that within one-year follow-up, CHF risk of BNP dynamic change group was significantly higher than that of no BNP dynamic change group(P=0.017). ROC curve analysis indicated that sensitivity of GRACE score, dynamic change of plasma BNP level and dual detection predicting CHF was 72.1%, 67.6% and 82.4% respectively, specificity was 64.9%, 91.7%, and 69.0% respectively, AUC were 0.705, 0.820 and 0.847 respectively; predictive value of plasma BNP level and dual detection for CHF were significantly higher than that of GRACE score(P=0.043, 0.001). Conclusion: Dynamic change of plasma BNP level during hospitalization combined GRACE score possesses certain predictive value for CHF in acute STEMI patients within one year after discharge.更多还原