CAJ | 학술논문

目的评估B型利钠肽(B-type natriuretic peptide,BNP)对急性ST段抬高性心肌梗死(ST-seg-ment elevation myocardial infarction,STEMI)溶栓治疗血管再通与否的预测价值.方法入选连续50例行溶栓治疗的AMI住院患者.选用尿激酶溶栓.以间接指标判断溶栓治疗效果.入院即时检测BNP.比较溶栓治疗失败组和成功组的临床特征.描绘BNP预测溶栓治疗失败的接收者工作特征(receiver operator characteristic,ROC)曲线.应用logistic回归分析筛选溶栓治疗失败的危险因素.结果溶栓治疗失败组患者的发病至溶栓时间较长.BNP水平、CK-MB峰值较高.BNP预测溶栓治疗失败的ROC曲线下面积为0.681(95%可信区间为0.533～0.829,P＝0.029).当BNP=97.2 ng/L时,其预测溶栓治疗失败的灵敏度、特异度最高,分别为63.3%、60.7%.若结合发病至溶栓时间>6 h,可提高其敏感度(76.3%)或特异度(93.0%).发病至溶栓时间延长、BNP升高是溶栓治疗失败的危险因子.结论入院即时床旁检测BNP水平对STEMI患者溶栓治疗疗效有一定的预测价值,如结合发病至溶栓时间可进一步提高其准确性.
목적 평고B형리납태(B-type natriuretic peptide,BNP)대급성ST단태고성심기경사(ST-seg-ment elevation myocardial infarction,STEMI)용전치료혈관재통여부적예측개치.방법 입선련속50례행용전치료적AMI주원환자.선용뇨격매용전.이간접지표판단용전치료효과.입원즉시검측BNP.비교용전치료실패조화성공조적림상특정.묘회BNP예측용전치료실패적접수자공작특정(receiver operator characteristic,ROC)곡선.응용logistic회귀분석사선용전치료실패적위험인소.결과 용전치료실패조환자적발병지용전시간교장.BNP수평、CK-MB봉치교고.BNP예측용전치료실패적ROC곡선하면적위0.681(95%가신구간위0.533～0.829,P＝0.029).당BNP=97.2 ng/L시,기예측용전치료실패적령민도、특이도최고,분별위63.3%、60.7%.약결합발병지용전시간>6 h,가제고기민감도(76.3%)혹특이도(93.0%).발병지용전시간연장、BNP승고시용전치료실패적위험인자.결론 입원즉시상방검측BNP수평대STEMI환자용전치료료효유일정적예측개치,여결합발병지용전시간가진일보제고기준학성.
Objective To assess the prognostic value of B - type natriuretic peptide (BNP) for effectiveness of thrombolysis in patients with ST - segment elevation myocardial infarction (STEMI). Methods Admission BNP level was assessed by point - of - care in 50 consecutive inpatients with STEMI treated with urokinase. Indirect indexes were assessed for evaluation of thrombolysis efficacy. The receiver operator characteristic (ROC) curve was established to evaluate the prognostic value of BNP. Furthermore, the logistic analysis was used to select the risk factors for unsuccessful thrombolysis. Results Delayed thrombolysis, high BNP level and creatine kinase - MB (CK - MB) peak level were risk factors of thrombolysis failure. The prognostic criteria for BNP level ( area under cure, 0.681) was 97.2 ng/L determined by ROC (P = 0.029), with a sensitivity and specificity of 63.3% and 60.7% , respectively. Combined with delayed thrombolysis (>6h) , the sensitivity rose to 76.3%, and the specificity rose to 93.0%. According to logistic analysis, the time from symptom onset to thrombolysis and elevated BNP level were independent risk factors for unsuccessful thrombolysis. Conclusion Elevated admission BNP is an independent predictor for unsuccessful thrombolysis in patents with STEMI. Combining with the time from symptom onset to thrombolysis, the prognstic value of elevated admission BNP is improved.