急性冠脉综合征患者白细胞计数、N末端B型脑钠肽原与GRACE评分联合检测的预测价值分析
|
摘要
目的分析急性冠脉综合征患者白细胞计数(WBC)、N末端B型脑钠肽原(NT-proBNP)与全球急性冠状动脉事件注册(GRACE)评分联合检测的预测价值。方法我院156例急性冠脉综合征患者,收集患者临床资料,进行GRACE评分。通过多因素Logistic回归分析影响患者预后的相关因素,并通过绘制受试者工作特征(ROC)曲线以分析联合检测WBC、NT-proBNP与GRACE评分对急性冠脉综合征的预测价值。结果死亡组WBC、NT-proBNP与GRACE评分较存活组均显著升高(P <0. 05)。多因素Logistic回归分析结果发现,WBC、NT-proBNP与GRACE评分均是评估患者死亡风险的独立危险因素(P <0. 05)。WBC、NT-proBNP与GRACE评分ROC曲线下面积分别为0. 66、0. 70、0. 76,其诊断阈值分别为9. 65×109/L、865. 50 pg/ml、153分,联合预测因子的曲线下面积为0. 91,诊断阈值为0. 13。结论联合检测WBC、NT-proBNP与GRACE评分对评估急性冠脉综合征死亡风险的预测价值明显优于单独检测,因此具有良好的临床评估价值。
Objective To investigate the predictive value of combined detection of white blood cells( WBC),N terminal probrain natriuretic peptide( NT-proBNP) and global registry of acute coronary events( GRACE) scores in patients with acute coronary syndrome.Methods The clinical data of 156 patients with acute coronary syndrome in our hospital were collected and scored with GRACE score. Multivariate logistic regression analysis was used to analyze the prognostic factors,and the receiver operating characteristic( ROC) curve was drawn to analyze the predictive value of combined detection of the three indexes in the patients.Results The WBC count,NT-proBNP levels and GRACE score in the death group were significantly higher than those in the survival group( P < 0. 05).Multivariate logistic regression analysis showed that WBC,NT-proBNP and GRACE scores were independent risk factors for assessing the mortality risk for the patients( P < 0. 05).The area under ROC curve of WBC,NT-proBNP and GRACE score was 0. 66,0. 70 and 0. 76,respectively. The diagnostic thresholds were 9. 65 × 109/L,865. 50 pg/ml and 153,respectively. The area under the curve of combined the three indexes was 0. 91,and the diagnostic threshold was 0. 13.Conclusion The combined detection of WBC,NT-proBNP and GRACE score is significantly better than single detection in predicting the mortality risk of acute coronary syndrome.Therefore,it has good clinical evaluation value.
Objective To investigate the predictive value of combined detection of white blood cells( WBC),N terminal probrain natriuretic peptide( NT-proBNP) and global registry of acute coronary events( GRACE) scores in patients with acute coronary syndrome.Methods The clinical data of 156 patients with acute coronary syndrome in our hospital were collected and scored with GRACE score. Multivariate logistic regression analysis was used to analyze the prognostic factors,and the receiver operating characteristic( ROC) curve was drawn to analyze the predictive value of combined detection of the three indexes in the patients.Results The WBC count,NT-proBNP levels and GRACE score in the death group were significantly higher than those in the survival group( P < 0. 05).Multivariate logistic regression analysis showed that WBC,NT-proBNP and GRACE scores were independent risk factors for assessing the mortality risk for the patients( P < 0. 05).The area under ROC curve of WBC,NT-proBNP and GRACE score was 0. 66,0. 70 and 0. 76,respectively. The diagnostic thresholds were 9. 65 × 109/L,865. 50 pg/ml and 153,respectively. The area under the curve of combined the three indexes was 0. 91,and the diagnostic threshold was 0. 13.Conclusion The combined detection of WBC,NT-proBNP and GRACE score is significantly better than single detection in predicting the mortality risk of acute coronary syndrome.Therefore,it has good clinical evaluation value.
引文
[1]Hosoya H,Levine JJ,Henry DH,et al.Double the trouble:Acute coronary syndrome and ischemic stroke in polycythemia vera[J]. Am J Med,2017,130(6):e237-e240.
[2]李恩,汪涛,张丽华,等.急性冠脉综合征患者血清mi RNA-208与血小板功能的关系[J].郑州大学学报(医学版),2017,52(2):188-190.
[3]宋雅信,赵晓燕,王小芳,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性冠脉综合征冠脉狭窄程度的关系[J].郑州大学学报(医学版),2016,51(6):780-784.
[4]Bekler A,Ozkan MT,Tenekecioglu E,et al.Increased platelet distribution width is associated with severity of coronary artery disease in patients with acute coronary syndrome[J]. Angiology,2015,66(7):638-643.
[5]汪晓莹,银鹏飞,黄永杰,等.非ST段抬高急性冠脉综合征患者GRACE评分与冠脉病变程度的相关性[J].中国老年学杂志,2012,32(23):5242-5243.
[6]Dehghani MR,Rezaei Y,Taghipour-Sani L.White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome[J].Cardiol J,2015,22(4):437-445.
[7]Taglieri N,Reggiani ML,Palmerini T,et al.Baseline white blood cell count is an independent predictor of long-term cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome,but it does not improve the risk classification of the GRACE score[J].Cardiology,2013,124(2):97-104.
[8]Arrebola-Moreno AL,Garcia-Retamero R,Catena A,et al.On the protective effect of resilience in patients with acute coronary syndrome[J].Int J Clin Health Psychol,2014,14(2):111-119.
[9]Dehghani MR,Rezaei Y,Fakour S,et al. White blood cell count to mean platelet volume ratio is a prognostic factor in patients with nonST elevation acute coronary syndrome with or without metabolic syndrome[J].Korean Circulat J,2016,46(2):229-238.
[10]许云梦,徐晓东,方中,等.白细胞计数/平均血小板体积比值及中性粒细胞/淋巴细胞比值评估急性冠脉综合征患者介入治疗预后的价值[J].安徽医学,2017,38(1):33-37.
[11]刘小波,武延红.BNP在心血管疾病中的应用进展[J].临床心身疾病杂志,2016,22(z2):87-88.
[12]赵艳军,王华荣,李富利,等.联合LVEF和NT-proBNP检测在症状不典型非ST抬高性急性冠脉综合征早期预后评估中的作用[J].实用医学杂志,2017,33(14):2311-2315.
[13]杨雯婷.IMA、hs-CRP、NT-proBNP及s CD40L指标在急性冠脉综合征早期诊断价值研究[J].中国实验诊断学,2016,20(12):2034-2037.
[14]雪锋,范文茂,庞军刚,等.急性冠脉综合征患者的平均血小板体积与GRACE评分的相关性[J].广东医学,2014,35(24):3811-3813.
[15]朱锐,吴校林,陶红,等.GRACE评分联合白细胞计数及hsCRP对冠状动脉病变程度的预测[J].海南医学,2013,24(21):3139-3142.
[2]李恩,汪涛,张丽华,等.急性冠脉综合征患者血清mi RNA-208与血小板功能的关系[J].郑州大学学报(医学版),2017,52(2):188-190.
[3]宋雅信,赵晓燕,王小芳,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性冠脉综合征冠脉狭窄程度的关系[J].郑州大学学报(医学版),2016,51(6):780-784.
[4]Bekler A,Ozkan MT,Tenekecioglu E,et al.Increased platelet distribution width is associated with severity of coronary artery disease in patients with acute coronary syndrome[J]. Angiology,2015,66(7):638-643.
[5]汪晓莹,银鹏飞,黄永杰,等.非ST段抬高急性冠脉综合征患者GRACE评分与冠脉病变程度的相关性[J].中国老年学杂志,2012,32(23):5242-5243.
[6]Dehghani MR,Rezaei Y,Taghipour-Sani L.White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome[J].Cardiol J,2015,22(4):437-445.
[7]Taglieri N,Reggiani ML,Palmerini T,et al.Baseline white blood cell count is an independent predictor of long-term cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome,but it does not improve the risk classification of the GRACE score[J].Cardiology,2013,124(2):97-104.
[8]Arrebola-Moreno AL,Garcia-Retamero R,Catena A,et al.On the protective effect of resilience in patients with acute coronary syndrome[J].Int J Clin Health Psychol,2014,14(2):111-119.
[9]Dehghani MR,Rezaei Y,Fakour S,et al. White blood cell count to mean platelet volume ratio is a prognostic factor in patients with nonST elevation acute coronary syndrome with or without metabolic syndrome[J].Korean Circulat J,2016,46(2):229-238.
[10]许云梦,徐晓东,方中,等.白细胞计数/平均血小板体积比值及中性粒细胞/淋巴细胞比值评估急性冠脉综合征患者介入治疗预后的价值[J].安徽医学,2017,38(1):33-37.
[11]刘小波,武延红.BNP在心血管疾病中的应用进展[J].临床心身疾病杂志,2016,22(z2):87-88.
[12]赵艳军,王华荣,李富利,等.联合LVEF和NT-proBNP检测在症状不典型非ST抬高性急性冠脉综合征早期预后评估中的作用[J].实用医学杂志,2017,33(14):2311-2315.
[13]杨雯婷.IMA、hs-CRP、NT-proBNP及s CD40L指标在急性冠脉综合征早期诊断价值研究[J].中国实验诊断学,2016,20(12):2034-2037.
[14]雪锋,范文茂,庞军刚,等.急性冠脉综合征患者的平均血小板体积与GRACE评分的相关性[J].广东医学,2014,35(24):3811-3813.
[15]朱锐,吴校林,陶红,等.GRACE评分联合白细胞计数及hsCRP对冠状动脉病变程度的预测[J].海南医学,2013,24(21):3139-3142.