CAJ | 학술논문

目的：通过对老年冠心病患者非心脏手术术前及术后肌钙蛋白T（TnT）和N末端B型利钠肽原（NT-proBNP）的测定，探讨TnT和NT-proBNP联合应用对老年冠心病患者非心脏手术围手术期心血管事件的预测价值。方法：入选60~82岁行择期非心脏手术患者共200例，分冠心病组118例和非冠心病组82例。分别测定术前1天及术后第2天的血清TnT和NT-proBNP浓度，记录两组患者围手术期心血管事件发生情况，探讨TnT和NT-proBNP对心血管事件的预测价值，利用ROC曲线确定最佳界值。结果：（1）冠心病组术后TnT及NT-proBNP浓度均高于术前及非冠心病组同期水平，差异有统计学意义（P均<0.05）。（2）总的心血管事件在冠心病组显著高于非冠心病组，差异有统计学意义（χ2=5.85，P<0.05），单项事件比较差异无统计学意义。（3）冠心病组，术前TnT预测围手术期总心血管事件的最佳界值为18.5 ng/L，灵敏度为72.0％，特异度为69.6％；术前NT-proBNP预测围手术期总心血管事件的最佳界值为98.0 pg/ml，灵敏度为90.8％，特异度为74.6％。（4）术前TnT升高患者总心血管事件高于TnT正常患者，差异有统计学意义（χ2=4.56，P=0.043），NT-proBNP升高患者总心血管事件同样高于NT-proBNP正常患者，差异有统计学意义（χ2=4.08，P=0.036）。TnT及NT-proBNP均升高患者总心血管事件显著高于两者均正常患者（χ2=13.32，P=0.000）。结论： TnT及NT-proBNP浓度均可作为评估老年冠心病患者非心脏手术围手术期心血管事件的心脏标志物，两者联用预测价值更高。
목적：통과대노년관심병환자비심장수술술전급술후기개단백T（TnT）화N말단B형리납태원（NT-proBNP）적측정，탐토TnT화NT-proBNP연합응용대노년관심병환자비심장수술위수술기심혈관사건적예측개치。방법：입선60~82세행택기비심장수술환자공200례，분관심병조118례화비관심병조82례。분별측정술전1천급술후제2천적혈청TnT화NT-proBNP농도，기록량조환자위수술기심혈관사건발생정황，탐토TnT화NT-proBNP대심혈관사건적예측개치，이용ROC곡선학정최가계치。결과：（1）관심병조술후TnT급NT-proBNP농도균고우술전급비관심병조동기수평，차이유통계학의의（P균<0.05）。（2）총적심혈관사건재관심병조현저고우비관심병조，차이유통계학의의（χ2=5.85，P<0.05），단항사건비교차이무통계학의의。（3）관심병조，술전TnT예측위수술기총심혈관사건적최가계치위18.5 ng/L，령민도위72.0％，특이도위69.6％；술전NT-proBNP예측위수술기총심혈관사건적최가계치위98.0 pg/ml，령민도위90.8％，특이도위74.6％。（4）술전TnT승고환자총심혈관사건고우TnT정상환자，차이유통계학의의（χ2=4.56，P=0.043），NT-proBNP승고환자총심혈관사건동양고우NT-proBNP정상환자，차이유통계학의의（χ2=4.08，P=0.036）。TnT급NT-proBNP균승고환자총심혈관사건현저고우량자균정상환자（χ2=13.32，P=0.000）。결론： TnT급NT-proBNP농도균가작위평고노년관심병환자비심장수술위수술기심혈관사건적심장표지물，량자련용예측개치경고。
Objective: To investigate the combined examination of plasma levels of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for predicting the risk of peri-operative cardiovascular events in elder coronary artery disease (CAD) patients with non-cardiac surgery. Methods: A total of 200 patients from (60-82) years of age with elective non-cardiac surgery were enrolled. The patients were divided into 2 groups: CAD group,n=118 and Non-CAD group,n=82. Plasma levels of TnT and NT-proBNP were examined at 1 day before and 2 days after the operation respectively. The cardiovascular events were recorded in both groups and the best cut-off values for TnT and NT-proBNP in risk prediction were evaluated by receiver operating characteristic (ROC) analysis. Results:①CAD group had the higher levels of post-operative TnT and NT-proBNP than pre-operative; both TnT and NT-proBNP levels were higher in CAD group than those in Non-CAD group at the same time points, allP<0.05.②The total cardiovascular events in CAD group was higher than those in non-CAD group (χ2=5.85,P=0.016) and the individual event was similar between 2 groups.③In CAD group, the best cut-off value for pre-operative TnT in predicting peri-operative cardiovascular events was 18.5 ng/L with the sensitivity at 72% and speciifcity at 69.6%; for NT-proBNP was 98.0 pg/ml with the sensitivity at 90.8% and speciifcity at 74.6%.④The patients with the higher level of pre-operative TnT had the increased risk of total cardiovascular events than those with normal TnT (χ2=4.56,P=0.043), and the same as NT-proBNP (χ2=4.08, P=0.036). Likewise, the patients with higher levels of both pre-operative TnT and NT-proBNP had the increased risk of total cardiovascular events than those with normal TnT and NT-proBNP (χ2=13.32,P=0.000). Conclusion:Either plasma levels of TnT or NT-proBNP could be used as the biomarker for predicting the risk of peri-operative cardiovascular events in elder CAD patients with non-cardiac surgery, the combined examination would have the better predictive value.