CAJ | 학술논문

目的：探讨B型利钠肽(β-type natriuretic peptide,BNP)预测老年病人腹部手术后心血管事件的价值。方法依据入院24 h 内血浆 BNP 水平将192例65岁以上择期行腹部手术病人分为两组,正常组(BNP≤100 ng/L)113例,升高组(BNP>100 ng/L)79例。比较两组病人术后不良心血管事件,并计算灵敏度、特异度、准确度、假阳性率、假阴性率、阳性预测值和阴性预测值,比较两组病例及发生不良心血管事件病例手术前后 BNP 变化。结果正常组无不良心血管事件发生,升高组中有24例发生不良心血管事件,两组间比较差异有统计学意义(P <0.05),BNP>100ng/L 预测术后不良心血管事件的灵敏度100%,特异度67.3%,准确度71.4%,假阳性率32.7%,假阴性率0,阳性预测值30.4%,阴性预测值100%。正常组术前、术后 BNP 水平分别为(45.3±23.1)ng/L 和(48.1±18.4)ng/L,手术前后比较差异无统计学意义(P >0.05)。升高组手术前后 BNP 水平分别为(168.7±87.4)ng/L 和(183.7±65.8)ng/L,手术前后比较差异有统计学意义(P <0.05)；其中,发生不良心血管事件24例,术后 BNP 水平为(268.3±102.4)ng/L,与术前(173.1±82.7)ng/L 比较差异有统计学意义(P <0.05)。结论术前 BNP >100 ng/L 对老年择期腹部手术后不良心血管事件有较好的预测价值,术后 BNP 显著升高与不良心血管事件相关。
목적：탐토B형리납태(β-type natriuretic peptide,BNP)예측노년병인복부수술후심혈관사건적개치。방법의거입원24 h 내혈장 BNP 수평장192례65세이상택기행복부수술병인분위량조,정상조(BNP≤100 ng/L)113례,승고조(BNP>100 ng/L)79례。비교량조병인술후불양심혈관사건,병계산령민도、특이도、준학도、가양성솔、가음성솔、양성예측치화음성예측치,비교량조병례급발생불양심혈관사건병례수술전후 BNP 변화。결과정상조무불양심혈관사건발생,승고조중유24례발생불양심혈관사건,량조간비교차이유통계학의의(P <0.05),BNP>100ng/L 예측술후불양심혈관사건적령민도100%,특이도67.3%,준학도71.4%,가양성솔32.7%,가음성솔0,양성예측치30.4%,음성예측치100%。정상조술전、술후 BNP 수평분별위(45.3±23.1)ng/L 화(48.1±18.4)ng/L,수술전후비교차이무통계학의의(P >0.05)。승고조수술전후 BNP 수평분별위(168.7±87.4)ng/L 화(183.7±65.8)ng/L,수술전후비교차이유통계학의의(P <0.05)；기중,발생불양심혈관사건24례,술후 BNP 수평위(268.3±102.4)ng/L,여술전(173.1±82.7)ng/L 비교차이유통계학의의(P <0.05)。결론술전 BNP >100 ng/L 대노년택기복부수술후불양심혈관사건유교호적예측개치,술후 BNP 현저승고여불양심혈관사건상관。
Objective To explore the predictive value of B-type natriuretic peptide (BNP)for postoperative major adverse cardiovascular events after elective abdominal surgery in elders.Methods A total of 192 patients aged over 65 years undergoing elective abdominal surgery were divided into normal (BNP≤100 ng/L,n=1 13)and increment (BNP>100 ng/L,n=79)groups based on preop-erative BNP concentration.The incidence of major adverse cardiovascular events were compared for both groups.And such parameters as sensitivity,specificity,accuracy,false positive,false negative, positive predictive value and negative predictive value were calculated.And the perioperative changes of BNP concentration were also compared for both groups.Results No major adverse cardiovascular event occurred in normal group.And 24 cases had major adverse cardiovascular events in increment group.There was significant inter-group difference.Based on a BNP concentration of > 100 ng/L in predicting major adverse cardiovascular events,the sensitivity,specificity,accuracy,false positive, false negative,positive predictive value and negative predictive value were 100%,67.3%,71 .4%, 32.7%,0,30.4% and 100% respectively.In normal group,no statistical significance existed be-tween preoperative and postoperative BNP values (45.3 ±23.1 vs 48.1 ± 1 8.4 ng/L,P >0.05 ).In increment group, postoperative BNP concentration was higher than its preoperative counterpart (1 83.7±65.8 vs 168.7±87.4 ng/L,P <0.05).In 24 patients with major adverse cardiovascular e-vents,the postoperative BNP concentration was higher than its preoperative counterpart (268.3 ± 102.4 vs 1 73.1 ±82.7 ng/L)(P <0.05).Conclusions After elective abdominal surgery,the risk of major adverse cardiovascular event in elders may be predicted with preoperative BNP concentration. And an elevated postoperative BNP concentration is associated with major adverse cardiovascular e-vents.