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目的:探讨并比较血浆脑钠肽(BNP)对不同年龄组急性冠脉综合征(ACS)患者经皮冠脉介入(PCI)术后临床主要不良心脏事件(MACE)的预测价值。方法:回顾分析2007年12月至2010年3月因ACS在我院行PCI的患者,分为≥60岁和<60岁两组,入院常规检验BNP,随访住院期间及出院后6个月内MACE(包括死亡、心源性休克、再发心绞痛、非致命性再次心肌梗死、非致命性心力衰竭、心律失常、靶血管血运重建、再次入院复合终点)的发生情况。结果:随访269例≥60岁患者,失访7例(2.6%),118例<60岁患者,失访3例(2.5%),。262例≥60岁患者的年龄与BNP水平显著正相关(r=0.368,P<0.01),而115例<60岁患者无显著相关性(r=-0.014,P>0.05)。年龄≥60岁患者BNP水平与<60岁患者比较,差异显著(P<0.01),年龄≥60岁患者MACE与<60岁患者比较,差异显著(P<0.01),两组患者BNP水平与LVEF呈显著负相关(P均<0.01)。多因素logistic回归分析显示:BNP可独立预测两组患者住院期间及出院后6个月内MACE(≥60岁OR=4.369 P<0.01;<60岁OR=7.773 P<0.01)发生率。两组患者BNP水平对MACE预测的ROC曲线结果比较,差异无统计学意义(P>0.05)。结论:不同年龄患者BNP水平及MACE发生率存在差异,但年龄并不影响BNP对ACS患者临床预后的预测价值。
Objective: To investigate and compare the predictive value of plasma brain natriuretic peptide (BNP) in clinical major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in different age groups. Methods: A retrospective analysis of patients with ACS who underwent ACS in our hospital from December 2007 to March 2010 was divided into two groups of ≥60 years old and <60 years old. BNP was routinely admitted during hospitalization and within 6 months after hospitalization The incidence of MACE (including death, cardiogenic shock, recurrent angina, nonfatal reoccurrence of myocardial infarction, nonfatal heart failure, arrhythmia, target vessel revascularization, and re-admission composite endpoints). Results: A total of 269 patients ≥60 years of age were followed up, 7 (2.6%) were lost to follow-up and 118 (60%) were lost to follow-up in 3 patients (2.5%). There were significant positive correlations between age and BNP level in 262 patients ≥60 years of age (r = 0.368, P <0.01), while no significant correlation was found in 115 patients <60 years of age (r = -0.014, P> 0.05). BNP levels in patients aged 60 years or older were significantly different from those in patients <60 years (P <0.01). MACE in patients aged 60 years or older was significantly different from patients <60 years (P <0.01). There was significant difference between BNP levels and LVEF There was a significant negative correlation (P <0.01). Multivariate logistic regression analysis showed that BNP could independently predict the incidence of MACE (OR = 4.369 P <0.01; OR = 7.773 P <0.01) in the two groups during hospitalization and 6 months after discharge. There was no significant difference in BNP level between the two groups on the ROC curve predicted by MACE (P> 0.05). CONCLUSIONS: There is a difference in BNP level and MACE incidence among different age groups, but age does not affect the predictive value of BNP in clinical prognosis of patients with ACS.