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[目的]探讨急性冠状动脉综合征(ACS)患者血浆N-末端脑利钠肽前体(NT-ProBNP)水平对临床预后的价值。[方法]纳入2007年1月～2009年12月138例符合诊断的ACS患者,入院24h内检测血浆NT-ProBNP水平,根据血浆NT-ProBNP水平分为3组:A组﹤200pg/L,B组200～500pg/L,C组﹥500pg/L。随访患者住院期间、30d、3个月主要心血管不良事件(包括心源性死亡,再次心肌梗死,再发心绞痛和心力衰竭的复合终点)发生率。[结果]138例ACS患者随着血浆NT-ProBNP水平的不同,各组住院期间及30d、3个月时心血管不良事件发生率呈明显不同。随着血浆NT-ProBNP水平的升高,B组(200～500pg/L)和C组(﹥500pg/L)在心源性死亡及再次心梗、再发心绞痛、心力衰竭等方面发生率呈明显递增趋势。3组心血管事件发生率分别为7.97%,28.99%,66.67%(P﹤0.01);经多变量Logistic回归分析显示,NT-ProBNP是ACS患者近期不良心血管事件的独立危险因素(OR=3.253,95%的可信区间1.582～6.992,P﹤0.01),结果显示其独立于年龄、吸烟史、心电图、Killip分级、左室射血分数、肌钙蛋白、肌酸激酶等临床评估因素。[结论]急性冠脉综合症患者血浆NT-ProBNP水平升高独立于各因素预测近期病死率及心血管不良事件发生率,对评估ACS患者近期临床预后具有重要价值。
[Objective] To investigate the clinical value of plasma N-terminal brain natriuretic peptide precursor (NT-ProBNP) level in patients with acute coronary syndrome (ACS). [Methods] A total of 138 ACS patients diagnosed from January 2007 to December 2009 were enrolled in this study. Plasma NT-ProBNP levels were measured within 24 hours after admission. Plasma NT-ProBNP levels were divided into 3 groups: group A (200pg / L, B Group 200 ~ 500pg / L, C group> 500pg / L. The incidence of major cardiovascular adverse events (including composite of cardiac death, repeated myocardial infarction, recurrent angina and heart failure) at 30 and 3 months after hospitalization was followed up. [Results] With the difference of plasma NT-ProBNP levels in 138 ACS patients, the incidence of cardiovascular adverse events was significantly different during hospitalization and at 30 and 3 months in each group. With the increase of plasma NT-ProBNP, the incidence of cardiac death and re-MI, recurrence of angina and heart failure were significantly higher in group B (200-500pg / L) and group C (> 500pg / L) Increasing trend. The multivariate logistic regression analysis showed that NT-ProBNP was an independent risk factor for recent adverse cardiovascular events in patients with ACS (OR = 3.253, P <0.01). The incidence of cardiovascular events was 7.97%, 28.99% and 66.67% , 95% confidence interval 1.582 ~ 6.992, P <0.01). The results showed that it was independent of clinical assessment factors such as age, smoking history, electrocardiogram, Killip classification, left ventricular ejection fraction, troponin and creatine kinase. [Conclusion] Elevated plasma levels of NT-ProBNP in patients with acute coronary syndrome are important predictors of the short-term clinical prognosis of patients with ACS, independent of their predictors of near-term mortality and cardiovascular adverse events.