本文選題：N末端腦鈉肽原 + 左心室射血分數(shù)��； 參考：《實用醫(yī)學雜志》2017年14期

【摘要】：目的探討N末端腦鈉肽原(NT-proBNP)和左心室射血分數(shù)(LVEF)在癥狀不典型非ST抬高性急性冠脈綜合征(NSTE-ACS)早期預后評估中的價值。方法回顧性分析2015年1月1日至2016年6月31日經(jīng)急診確診并入院的248例急性心肌梗死的患者資料,按照心電圖改變分為NSTE-ACS和STE-ACS組,分別記錄其年齡、性別、既往病史、吸煙史、就診癥狀、是否表現(xiàn)為胸痛、從發(fā)病到就診時間(院前時間)、從就診到接受經(jīng)皮冠狀動脈介入(PCI)或溶栓等治療的時間(急診時間)、28 d是否死亡,如果死亡則記錄發(fā)病至死亡的時間(生存時間);記錄患者來急診即接受的檢查的結(jié)果,包括血常規(guī)、心肌損傷標志物(CK-MB\MYO\CTNI)、D-二聚體、NT-proBNP、LVEF等指標,進行多因素Logistic回歸分析并繪制受試者工作特征曲線(ROC曲線),同時建立Cox回歸模型,并繪制生存曲線,以分析NT-proBNP和LVEF對心梗后早期預后(28 d死亡)的預測價值。結(jié)果對NSTE-ACS和STE-ACS組分析發(fā)現(xiàn),NSTE-ACS組以胸痛為主訴就診的患者比例低于后者(33.6%vs.70.1%,P=0.003),院前時間長于后者(67.92±116.89 vs.30.65±55.59,P=0.006),CTNI(4.37±12.53 vs.9.62±18.00,P=0.011)和LVEF(53.51±14.51 vs.56.26±12.30,P=0.019)低于后者,NT-proBNP高于后者(2 288.37±4 612.10 vs.1 506.84±1 722.51,P=0.038),而病死率高于前者(15.3%vs.6.8%,P=0.036)。Logistic回歸方程分析提示LVEF與28 d病死率負相關(guān)(B=-0.097,P=0.022),ROC曲線下面積0.783,NT-pro BNP與LVEF進行擬合后繪制ROC曲線下面積0.901,提示評價效果優(yōu)于單一因素。且NT-proBNP與LVEF呈負相關(guān)(r=-0.263,P=0.001),Cox回歸模型生存曲線提示LVEF(B=0.401,P=0.045)越大,生存時間越長,NT-proBNP(B=0.00,P=0.931)與生存時間無關(guān)。結(jié)論聯(lián)合LVEF和NT-proBNP檢測有助于臨床醫(yī)師早期對癥狀不典型的NSTE-ACS患者的危險程度作出評估,以改善患者的預后。
[Abstract]:Objective to investigate the value of NT-proBNPs and left ventricular ejection fraction (LVEF) in the early prognostic evaluation of atypical ST-elevation acute coronary syndrome (ACS). Methods from January 1, 2015 to June 31, 2016, the data of 248 patients with acute myocardial infarction were analyzed retrospectively. According to the changes of ECG, they were divided into NSTE-ACS group and STE-ACS group. Their age, sex, medical history and smoking history were recorded respectively. The symptoms of the visit were chest pain, the time from onset to visit (pre-hospital time), from visit to percutaneous coronary intervention (PCI) or thrombolytic therapy (emergency time was 28 days). If the patient died, the time from onset to death (survival time) was recorded. The results of the emergency examination were recorded, including blood routine examination, myocardial injury marker CK-MB\ MYO\ CTNININ D- dimer NT-proBNPN LVEF, and so on. Multivariate Logistic regression analysis was performed and the operating characteristic curve of subjects was drawn. Meanwhile, Cox regression model was established and survival curve was drawn to analyze the predictive value of NT-proBNP and LVEF for early prognosis of 28 days after myocardial infarction (MI). 緇撴灉瀵筃STE-ACS鍜孲TE-ACS緇勫垎鏋愬彂鐜，

本文編號：1904770