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|本期目录/Table of Contents|

N末端脑钠尿肽原预测老年人腹部手术后心脏事件的价值

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第6期
页码:
744-747
栏目:
临床研究
出版日期:
2011-12-25

文章信息/Info

Title:
Predictive value of N-terminal pro-brain natriuretic peptide for perioperative major cardiovascular events in elderly patients undergoing abdominal surgery
作者:
龚卫琴; 高德伟; 王 蓉; 李文兵; 卢文宁; 刘朝阳; 蔡 毅
解放军总医院南楼临床部外二科，北京100853
Author(s):
GONG Wei-qin;  GAO De-wei;  WANG Rong;  LI Wen-bing;  LU Wen-ning;  LIU Chao-yang;  CAI Yi
Second Surgery Department, South Building, PLA General Hospital, Beijing 100853, China
关键词:
N末端B型钠尿肽原; 手术; 心脏事件; 老年
Keywords:
N-terminal pro-brain natriuretic peptide;  surgery;  cardiac events;  elderly patients
分类号:
R572
DOI:
-
文献标识码:
A
摘要:
目的:探讨术前血浆N末端脑钠尿肽原（NT-proBNP）水平对老年腹部手术患者围手术期严重心血管事件（PMCE）的预测价值。方法： 检测173例拟实施腹部手术老年患者的术前血浆NT-proBNP浓度，通过ROC曲线下面积比较术前血浆NT-proBNP水平和修订心脏风险指数（RCRI）在预测老年腹部手术患者围手术期发生PMCE的价值并找出理想截断点值。结果： 围手术期发生PMCE 12例，PMCE组血浆NT-proBNP浓度显著高于无PMCE组，中位数分别为452.6 ng/L和67.1 ng/L，NT-proBNP-log分别为2.72±0.43和1.82±0.39，P<0.01。术前血浆NT-proBNP的ROC曲线下面积为0.964（95%CI 0.924-0.986，P<0.01），RCRI的ROC曲线下面积为0.79（95%CI 0.722-0.848，P<0.01），二者的曲线下面积比较相差0.174，P<0.05。NT-proBNP预测围手术期PMCE的截断点为230.2 ng/L，其诊断灵敏度、特异度和准确度分别为92% 、96%和 96%。结论： 术前血浆NT-proBNP能预测老年腹部手术患者PMCE的发生，可以作为术前风险评估的工具。
Abstract:
AIM:To investigate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in predicting perioperative major cardiovascular events (PMCE) in elderly patients undergoing abdominal surgery. METHODS: NT-proBNP was determined preoperatively in 173 patients undergoing surgery. ROC analyses were performed to evaluate the predictive values of plasma NT-proBNP and revised cardiac risk index (RCRI) for perioperative PMCE in elderly patients undergoing abdominal surgery and to identify the optimal NT-proBNP cut-off for predicting perioperative PMCE. RESULTS: Twelve patients developed perioperative complications of PMCE. Preoperative NT-proBNP levels were significantly higher in patients experiencing cardiac events compared with the levels in patients without events (median 452.6 ng/L vs. 67.1 ng/L; NT-proBNP-log 2.72/0.43 vs. 1.82/0.39, P<0.01). In a receiver-operator characteristic (ROC) analysis for the prediction of PMCE, the area under ROC curve for NT-proBNP was significantly higher than the area under ROC curve for RCRI (0.964, 95% CI 0.924-0.986, P<0.01) vs. 0.79, 95% CI 0.722-0.848, P<0.01) (P<0.05). The optimal predictive accuracy was achieved with a NT-proBNP threshold of 230.2 ng/L. CONCLUSION: In elderly patients undergoing abdominal surgery, preoperative NT-proBNP level can predict short-term postoperative PMCE. NT-proBNP is a useful tool in the preoperative evaluation of elderly patients undergoing abdominal surgery.

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备注/Memo

备注/Memo:
收稿日期：2011-03-17.通讯作者：龚卫琴，主任医师，主要从事老年心血管病基础和临床研究Email:gongwq6228@yahoo.com.cn
更新日期/Last Update: 2011-12-27