B型利钠肽联合TIMI危险积分对STEMI患者远期死亡风险预警价值的研究.docVIP

B型利钠肽联合TIMI危险积分对STEMI患者远期死亡风险预警价值的研究 赵睿1 佘强2 杨蕊1 杜建霖2 邓松柏2 王喜春2 夏爽2 (1，重庆市第九人民医院ICU,重庆400700； 2，重庆医科大学附属第二医院心血管内科,重庆400010 ） 【摘要】: 目的：评价B型利钠肽(B-type natriuretic peptide，BNP）联合TIMI危险积分对急性ST段抬高型心肌梗死（STEMI）患者远期死亡率预警价值。方法：345例STEMI患者在首发胸痛24小时内采血测定血浆BNP水平，并进行TIMI风险积分评定。对纳入病例进行长期随访，随访终点为全因性死亡，包括心血管病死亡和非心血管病死亡。结果：平均随访314±208天，死亡率为（69人）20.0%。远期死亡率与高TIMI积分密切相关（P0.001）。血浆BNP水平升高与远期死亡率增加相关（中位数［ 全距］ng/L，存活者447.5［ 8-2854］vs 死亡者986.0［ 31-4986］，P﹤0.001）。多因素Cox分析表明，发病24小时内血浆BNP水平升高和TIMI危险积分均为预测远期死亡风险升高的独立可靠指标（BNP，2.608［95%CI, 1.840-3.696], P0.001；TIMI危险积分，1.227［95%CI, 1.138—1.323]，P0.001）。Kapian-Meier生存曲线分析结果为BNP低于中位数者较高于中位数者远期预后明显较佳（P＜0.001）。远期生存曲线下面积(AUC) BNP为O.797 (P0.001)，而TlMI危险积分0.780 (P0.001)，TIMI积分联合BNP可以提高预测死亡率的价值（AUC,0.853，P0.001)）。结论：发病24小时内测定BNP水平和TIMI危险积分评定能可靠的预测STEMI患者远期死亡风险，BNP水平与TIMI危险积分两者联合能提高其预测远期死亡风险的价值。 【关键词】: B型利钠肽; TIMI危险积分；ST段抬高心肌梗死;远期死亡率; 危险分层 A Study on the Value of B-type natriuretic peptide combines the TIMI risk score in predicting late mortality in Patients with ST-segment Elevation Myocardial Infarction ZHAO Rui, DU Jianlin, DEN Songbai, WANG Xichun, XIA Shuang (1,Department of ICU, The Ninth Peoples Hospital of Chongqing, Chongqing 400700. 2,Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010) Abstract：Objective: Assessment of the value of B-type natriuretic peptide levels combines TIMI risk scores in predicting late mortality in patients with ST-segment Elevation Myocardial Infarction（STEMI）. Methods: 345 patients with STEMI were studied. Blood was drawn and the plasma concentration of BNP was determined within 24 hours after the onset of chest pain and the patients’ TIMI risk score was measured . The all-cause mortality, including cardiac and non-cardiac deaths during Long-term follow-up, was recorded. Results: Mortality was 20.0％（n=69） during a follow-up of 314±208 days .The late mortality was related to higher TIMI risk scores (P0.001). Higher BNP levels were also related to incre