Abstract:【Objective】To analyze the predictive value of NT-proBNP in patients with acute coronary syndrome (ACS). 【Methods】From October 2014 to August 2015, the clinical data of 364 patients with ACS were collected from our hospital. The venous blood was taken from them 1~3 days after admission, and the levels of NT-proBNP and troponin cTnT or cTnI were examined. Left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction (LVEF) were examined by echocardiography. Patients were followed up for 24 months by outpatient or telephone to record cardiac death.【Results】Among the 343 patients, there were 148 cases of ST-segment elevation myocardial infarction(STEMI), 54 cases of acute non-ST-segment elevation myocardial infarction(NSTEMI) and 141 cases of unstable angina pectoris(UA). There were significant differences in the positive rate of age, hypertension,hypercholesterolemia,LVEF,InNT-proBNP,cTnT or cTnI between the STEMI group ,the NSTEMI group and the UA group (P<0.05). According to whether they died of cardiogenic disease, they were divided into two groups: the death group (n=20) and the survival group (n=321). The positive rate of cTnT or cTnI in the death group was significantly higher than that in the survival group (P<0.05). The age, positive rate of cTnT or cTnI , LVEF and InNT-proBNP in the dead group were significantly higher than those in the survival group (P<0.05). NT-proBNP was an independent predictor of cardiac death (P<0.05 ) , the area under ROC curve was 0.773 (P=0.000 ) . When the optimum threshold point of NT-proBNP was set at 1269 fmol/mL according to the ROC curve, the highest accuracy was 82.5%.【Conclusion】NT-proBNP is a good predictor of mid-term cardiac death in patients with acute coronary syndrome.
刘蓉, 乔树宾. 氨基末端B型脑钠肽前体对急性冠脉综合征患者中期心源性病死的预测价值[J]. 医学临床研究, 2018, 35(5): 867-869.
LIU Rong, QIAO Shu-bin. Analysis of the Predictive Value of NT-proBNP in Patients with Acute Coronary Syndrome (ACS). JOURNAL OF CLINICAL RESEARCH, 2018, 35(5): 867-869.
[1] Hall C. Essential biochemistry and physiology of NT-proBNP[J]. Eur J Heart Fail,2004,6(3):257-260.
[2] The potential role of natriuretic peptides and other biomarkers in heart failure diagnosis, prognosis and management.Ibrahim N, Januzzi JL[J].Expert Rev Cardiovasc Ther, 2015,13(9):1017-1030.
[3] Yancy CW,Jessup M,Bozkurt B, et al.2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013 ,62(16):147-239.
[4] Leto L, Testa M, Feola et al. The predictive value of plasma biomarkers in discharged heart failure patients: role of plasma NT-proBNP[J].Minerva Cardioangiol, 2016,64(2):157-164.
[5] Ponikowski P, Voors AA, Anker SD, et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J]. Eur Heart J. 2016,37,2129-2200.
[6] Roberts E, Ludman AJ, Dworzynski K,et al. NICE Guideline Development Group for Acute Heart Failure. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting[J]. BMJ, 2015, 350,h910.
[7] Klingenberg R, Aghlmandi S, Rber L,et al.Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score[J].Eur Heart J Acute Cardiovasc Care,2016,1:204887.
[8] He PC, Duan CY, Liu YH,et al.N-terminal pro-brain natriuretic peptide improves the C-ACS risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction[J].BMC Cardiovasc Disord, 2016 ,16(1):255.
[9] Kang Q, Wan Z, Huang Z.N-terminal probrain natriuretic peptide in patients with acute coronary syndrome[J].Int J Clin Pharmacol Ther, 2017,55(1):78-84.
[10] Radwan H, Selem A, Ghazal K.Value of N-terminal pro brain natriuretic peptide in predicting prognosis and severity of coronary artery disease in acute coronary syndrome[J].J Saudi Heart Assoc,2014,26(4):192-198.
[11] Omland T, Persson A, Ng L, et al.N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes[J]. Circulation,2002,106(23):2913-2918.
[12] Takase H, Dohi Y.Kidney function crucially affects B-type natriuretic peptide (BNP), N-terminal proBNP and theirrelationship[J].Eur J Clin Invest, 2014,44(3):303-308.
[13] Luchner A, Behrens G, Stritzke J,et al.Long-term pattern of brain natriuretic peptide and N-terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors[J].Eur J Heart Fail, 2013 ,15(8):859-867.
[14] Martín-Reyes R, Franco-Peláez JA, Lorenzo ó,et al. Levels of monocyte chemoattractant protein-1, n-terminal fragment of brain natriuretic peptide and calcidiol are independently associated with thecomplexity of coronary artery disease[J]. PLoS One,2016,11(5):e0152816.