急性心肌梗死后血B型尿钠肽水平与急诊经皮冠状动脉介入及远期死亡率的相关性分析
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Correlationship of B-type natriuretic peptide level with emergency percutaneous coronary intervention therapy and long-term mortality in acute myocardial infarction patients
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    摘要:

    目的探讨急性心肌梗死(AMI)急性期血B型尿钠肽水平(BNP)是否受急诊经皮冠状动脉介入(PCI)影响,及其对患者远期死亡率的预测价值。方法连续录入心脏病监护病房住院的230例AMI患者,对比急诊PCI与未行急诊PCI治疗组血BNP水平的差别;对该组患者进行随访,平均(38.1±8.5)个月,随访率86.1%;记录AMI后3年发生的心源性死亡情况;采用Kaplan-Meier曲线进行无心源性死亡生存率分析,并采用LogRank法对比不同BNP水平患者生存率的差别。结果经急诊PCI治疗患者在AMI急性期LnBNP显著低于未行急诊PCI治疗组(5.0±1.2vs5.8±1.3,P<0.001),3年期随访心源性死亡患者LnBNP显著高于存活组(6.6±1.1vs5.3±1.3,P<0.001);经急诊PCI治疗患者生存率显著高于后者(93.4%vs77.5%,P<0.01)。通过绘制ROC曲线,BNP=316.5ng/L被确定为分界点把患者分成高BNP水平组和低BNP水平组。经Kaplan-Meier曲线分析提示,两组生存曲线显著分离。经Log Rank分析提示,低BNP水平组生存率显著高于高BNP水平组(95.1%vs66.4%,P<0.001)。结论急诊PCI治疗可显著降低AMI急性期血BNP水平。BNP是AMI远期预后的优良血清标记物,与患者远期死亡率相关。

    Abstract:

    Objective To discuss whether the B-type natriuretic peptide (BNP) level in acute phase of acute myocardial infarction (AMI) was affected by emergency percutaneous coronary intervention(PCI) therapy,and whether it was predictive of the long-term mortality of AMI patients. Methods Two hundred and thirty consecutive AMI patients in CCU were enrolled. The BNP level was compared between emergency PCI group and non-PCI group. The patients were followed up for a period of (38.1±8.5) months averagely,with follow-up rate of 86.1%. The cardiogenic death cases were recorded. Survival rate of non-cardiogenic death cases was analyzed with Kaplan-Meier curve. Survival rate of patients with different levels of BNP was compared with Log Rank method. Results LnBNP was significantly lower in emergency PCI group than in non-PCI group(5.0±1.2 vs 5.8±1.3,P<0.001). LnBNP after 3-year follow-up visit was significantly lower in survival group than in cardiogenic death group(5.3±1.3 vs 6.6±1.1,P<0.001). The survival rate was significantly higher in emergency PCI group than in non-PCI group(93.4% vs 77.5%,P<0.001). BNP of 316.5ng/L was determined as the cut-off point according to ROC curve. The Kaplan-Meier curves demonstrated that the survival curves of the two groups separated apparently. Log Rank analysis displayed that the survival rate was significantly higher in low BNP level group than in high BNP level group (95.1% vs 66.4%,P<0.001). Conclusion Emergency PCI could reduce BNP level in acute phase of AMI. BNP is an excellent biomarker for long-term outcome of AMI and is strongly correlated with the long-term mortality of AMI.?更多

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毛懿 杨跃进 张健 倪新海 陈纪林 高润霖 陈在嘉.急性心肌梗死后血B型尿钠肽水平与急诊经皮冠状动脉介入及远期死亡率的相关性分析[J].中华老年多器官疾病杂志,2009,8(6):541~543+552

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