發(fā)布時(shí)間：2018-06-27 18:49

  本文選題：B型利鈉肽 + 高敏肌鈣蛋白T��； 參考：《青島大學(xué)》2015年博士論文

【摘要】：目的:探討生化標(biāo)記物BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3以及聯(lián)合GRACE評分對高齡非ST抬高型急性冠脈綜合征(NSTACS)左心收縮功能正常患者1年終點(diǎn)事件的風(fēng)險(xiǎn)評估價(jià)值,并探討B(tài)NP、hs-c Tn T、GDF-15、Copeptin、PTX-3不同水平早期介入治療的作用。方法:選擇年齡≥75歲NSTACS肌鈣蛋白T、左心收縮功能正�；颊�204例,男性95例,女性109例,平均發(fā)病時(shí)間8.3±2.4小時(shí),平均年齡78.1±2.0歲。對所有患者測定BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平,并隨機(jī)分為早期介入組與藥物保守組,對早期介入組48小時(shí)內(nèi)行冠脈造影,記錄冠脈病變支數(shù)、病變程度,計(jì)算Gensini積分。對所有患者隨訪1年,觀察1年終點(diǎn)事件(非致死性心梗、心血管死亡)。通過生存曲線、COX模型、ROC曲線分析BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3與1年終點(diǎn)事件的關(guān)系,以及聯(lián)合GRACE評分對1年終點(diǎn)事件的風(fēng)險(xiǎn)評估價(jià)值,并用"緼UC、IDI、NRI統(tǒng)計(jì)學(xué)指標(biāo)進(jìn)行比較。同時(shí)對早期介入組與藥物保守組BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3不同水平終點(diǎn)事件進(jìn)行比較分析。結(jié)果:1.三支、雙支血管病變患者BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平高于單支血管病變患者(P0.05),冠脈完全閉塞、重度狹窄患者高于輕度、中度狹窄患者(P0.05),與Gensini積分呈正相關(guān)性。2.1年終點(diǎn)事件患者BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平均高于未發(fā)生終點(diǎn)事件的患者(P0.05);BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3高水平患者生存時(shí)間小于低水平患者(P=0.004;P=0.017;P=0.004;P=0.018;P=0.010)。3.COX模型分析BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3高水平患者1年終點(diǎn)事件風(fēng)險(xiǎn)分別為4.339(95%CI 1.114-15.091,P=0.014)、4.571(95%CI1.152-15.873,P=0.012)、4.273(95%CI 1.056-14.147,P=0.016)、2.640(95%CI1.037-10.773,P=0.044)、3.753(95%CI 1.093-13.801,P=0.027),并獨(dú)立于GRACE評分。4.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3預(yù)測1年終點(diǎn)事件的ROC曲線下面積分別為0.689(95%CI 0.656-0.763)、0.696(95%CI 0.667-0.797)、0.717(95%CI0.684-0.825)、0.690(95%CI 0.661-0.779)、0.715(95%CI 0.673-0.819),與GRACE評分ROC曲線下面積比較無差異(P0.05)。5.BNP聯(lián)合GRACE評分預(yù)測1年終點(diǎn)事件ROC曲線下面積為0.741(95%CI 0.711-0.856),"緼UC為0.034(95%CI 0.006-0.053),IDI為0.028(95%CI 0.013-0.042),NRI(0)為0.410(95%CI 0.111-0.638);hs-c Tn T聯(lián)合GRACE評分ROC曲線下面積為0.722(95%CI 0.696-0.814),"緼UC為0.015(95%CI0.001-0.027),IDI為0.010(95%CI 0.001-0.018),NRI(0)為0.428(95%CI0.202-0.654);GDF-15聯(lián)合GRACE評分ROC曲線下面積為0.745(95%CI 0.712-0.873),"緼UC為0.038(95%CI 0.007-0.058),IDI為0.034(95%CI 0.015-0.062),NRI(0)為0.454(95%CI 0.229-0.679);Copeptin聯(lián)合GRACE評分ROC曲線下面積為0.730(95%CI0.703-0.828),"緼UC為0.023(95%CI 0.004-0.039),IDI為0.015(95%CI0.008-0.026),NRI(0)為0.351(95%CI 0.125-0.576);PTX-3聯(lián)合GRACE評分ROC曲線下面積為0.736(95%CI 0.710-0.841),"緼UC為0.029(95%CI 0.005-0.042),IDI為0.018(95%CI 0.004-0.030),NRI(0)為0.395(95%CI 0.167-0.622)。6.早期介入組1年終點(diǎn)事件發(fā)生率低于藥物保守組,生存時(shí)間長。兩組hs-c Tn T、GDF-15、PTX-3不同水平患者1年終點(diǎn)事件比較有差異(P0.05),而兩組BNP、Copeptin不同水平患者1年終點(diǎn)事件比較無差異(P0.05)。結(jié)論:1.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3與高齡NSTACS左心收縮功能正常患者冠脈病變程度密切相關(guān)。2.BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3可預(yù)測高齡NSTACS左心收縮功能正�；颊�1年終點(diǎn)事件風(fēng)險(xiǎn),BNP、hs-c Tn T、GDF-15、Copeptin、PTX-3水平越高,1年終點(diǎn)事件風(fēng)險(xiǎn)越高,聯(lián)合GRACE評分,可增強(qiáng)GRACE評分風(fēng)險(xiǎn)預(yù)測能力,其中GDF-15、BNP聯(lián)合GRACE評分風(fēng)險(xiǎn)預(yù)測能力較強(qiáng)。3.早期介入治療能降低高齡NSTACS左心收縮功能正常GDF-15、hs-c Tn T、PTX-3高水平患者發(fā)生終點(diǎn)事件的風(fēng)險(xiǎn),對早期介入治療有指導(dǎo)意義;但介入治療不能降低高齡NSTACS左心收縮功能正常BNP、Copeptin高水平患者發(fā)生終點(diǎn)事件的風(fēng)險(xiǎn),對早期介入治療無指導(dǎo)意義,對如何降低高齡NSTACS左心收縮功能正常BNP、Copeptin高水平患者發(fā)生終點(diǎn)事件的風(fēng)險(xiǎn),需要進(jìn)一步探討。
[Abstract]:Objective: To evaluate the value of biochemical markers BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 and combined GRACE score on the risk assessment of the 1 year endpoint events in patients with normal left heart systolic function in elderly patients with non ST elevation acute coronary syndrome (NSTACS) and explore the role of BNP, HS-C, and different levels of early intervention. The patients aged 75 and 75 years old, 204 cases of normal left cardiac contractile function, 95 men and 109 women, average age 8.3 + 2.4 hours, average age 78.1 + 2 years. All patients were measured BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 level, and randomly divided into early intervention group and drug conservative group, for the early intervention group 48 hours. Internal coronary angiography, record coronary artery disease count, degree of lesion, and calculate Gensini score. Follow up to all patients for 1 years, observe 1 year endpoint events (non lethal myocardial infarction, cardiovascular death). Analyze the relationship between BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 and 1 year end events through the survival curve, COX model, ROC curve, and the combined GRACE score to 1 The value of risk assessment of year-end point events was compared with "UC, IDI, NRI statistics". At the same time, the results were compared between the early intervention group and the conservative group BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3. Patients with vascular lesions (P0.05) were completely blocked and patients with severe stenosis were higher than mild, moderate stenosis patients (P0.05), and Gensini scores were positively correlated with BNP, HS-C Tn T, GDF-15, Copeptin, and PTX-3 level in patients with.2.1 year end events. The time less than low level (P=0.004; P=0.017; P=0.004; P=0.018; P=0.010).3.COX model analysis BNP, HS-C Tn T, GDF-15, Copeptin, the risk of the 1 year end event of the high level patients was 4.339, 4.571 (95%), 4.273 044), 3.753 (95%CI 1.093-13.801, P=0.027), and independent of the GRACE score.4.BNP, HS-C Tn T, GDF-15, Copeptin, PTX-3 prediction 1 year end events under the ROC curve area of 0.689, 0.696 (95%), 0.690 (95%), 0.715 (0.715), and 0.715 The lower area (P0.05).5.BNP combined GRACE score predicted that the area under the ROC curve of the 1 year end event was 0.741 (95%CI 0.711-0.856), "UC was 0.034 (95%CI 0.006-0.053), IDI was 0.028 (95%CI 0.013-0.042), and 0) was 0.410. For 0.015 (95%CI0.001-0.027), IDI is 0.010 (95%CI 0.001-0.018), NRI (0) is 0.428 (95%CI0.202-0.654); the area under ROC curve of GDF-15 combined GRACE score is 0.745 (95%CI 0.712-0.873) and 0.034 (0) is 0.454. The product is 0.730 (95%CI0.703-0.828), "UC is 0.023 (95%CI 0.004-0.039), IDI is 0.015 (95%CI0.008-0.026), NRI (0) is 0.351 (95%CI 0.125-0.576); PTX-3 United GRACE score is 0.736 under ROC curve," 0.029 (95%). 0) is 0.395. The incidence of 1 year endpoints in the early intervention group was lower than that in the conservative group, and the survival time was longer. The 1 year end events of the two groups of HS-C Tn T, GDF-15 and PTX-3 were different (P0.05), while the 1 year end events of the two groups of BNP and Copeptin were no difference (P0.05). The degree of coronary lesions in patients with normal left cardiac contractile function is closely related to the degree of coronary artery disease (.2.BNP), HS-C Tn T, GDF-15, Copeptin, and PTX-3 can predict the risk of 1 year endpoint event in patients with normal systolic function in the elderly, BNP, HS-C Tn, the higher the level, the higher the risk of the end of the 1 year. Test ability, of which GDF-15, BNP combined with GRACE scoring risk prediction ability,.3. early intervention therapy can reduce the elderly NSTACS left cardiac contractile function normal GDF-15, HS-C Tn T, PTX-3 high level patients have the risk of endpoint events, the early intervention therapy has guidance significance, but the introduction of treatment can not reduce the age NSTACS left ventricular systolic function normal B. The risk of endpoint events in NP, Copeptin high level patients is not instructive for early intervention therapy. It is necessary to further explore how to reduce the risk of end-point events in patients with advanced NSTACS left cardiac contractile function and Copeptin high level patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R541.4

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本文編號：2074878