NỒNG độ NT proBNP HUYẾT THANH và THANG điểm NGUY cơ GRACE TRONG TIÊN LƯỢNG NGẮN hạn ở BỆNH NHÂN hội CHỨNG VÀNH cấp

N NT-proBNP HUY
NG NGN HN  BNH NHÂN HI CHNG VÀNH CP

Trn Vit An
1
,

2
,

3
1
ng i hc C
2
Trường Đại học Y Dược Huế;
3
Bệnh viện Trung ương Huế



 k-

-
 t

 g-

(EF= 45-     -     
--
-pr



-proBNP là 0,920 (95% KTC= 0,86-0,96) và p <0,001.
 n-
-


SUMMARY
NT-proBNP SERUM AND GRACE SCORE IN SHORT-TERM PROGNOSIS
OF PATIENTS WITH ACUTE CORONARY SYNDROMES
Objectives: Investigate the relationship between serum NT-proBNP concentration with
cardiovascular events after acute coronary syndromes (ACS). Assessing the value of short-term
prognosis of the GRACE score combined with NT-proBNP in patients with ACS.
Methods: Prospective study. The main outcome measures was mortality, myocardial
infarction and heart failure hospitalization within 30 days.
Results: The study population consisted of 127 patients with ACS. Serum NT-proBNP
concentration between the groups in left ventricular ejection fraction, normal  
809.7 pg/ml, mild reduction of EF (EF= 45-54%) was 1893.7 pg/ml and average reduction (EF=
30-44%) was 2851.2 pg/ml (p <0.001). There was a strong inverse correlation between NT-
proBNP and left ventricular ejection fraction after ACS (r= -0.503; p <0.001). Optimal NT-
proBNP cut-points for prediction of 30-day mortality has >2037 pg/ml with a sensitivity of
100% and a specificity of 76.7%, and area under the curve was 0.917 (p <0.001). Area under the
curve of the GRACE score was 0.836 (p = 0.003) and a new score GRACE + NT-proBNP was
0.920 (95% CI = 0.86 to 0.96) and p <0.001.
Conclusions: Serum NT-proBNP concentration is strong associated with mortality and heart
failure after acute coronary syndromes. The combination of GRACE score and NT-proBNP to
predict short-term mortality in patients with acute coronary syndromes.


                

 Theo
-
-42%.
 



-


-





-

       -proBNP


-

-




 


 Và 

1
-V
2
Hoặc
                


 


 suy tim và NMCT.


Killip


HATT
(mmHg)



(l/p)



Creatinin
(µmol/L)


I
II
III
IV
0
21
43
64
< 80
80-99
100-119
120-139
140-159
160-199

63
58
47
37
26
11
0
< 70
70-89
90-109
110-149
150-199

0

7
13
23
36
46
< 40
40-49
50-59
60-69
70-79

0
18
36
55
73
91
0-34
35-70
71-105
106-140
141-176
177-353

2
5
8
11
14
23

31



ST chên

 = 


HCVC không có ST chênh lên







1  108
< 1
49  125
< 2
Trung bình
109  140
1  3
126  154
2  5
Cao
141 - 372
> 3
155 - 319

> 5


trên máy siêu âm màu A

SP1 (© Koninklijke Philips Electronics N.V.2006) qua thông tim.
-
45--

Phân tích sinh hoá NT-


-pro-
31,88±28,84 pg/ml và 
 



- -

3.1. 

NMCTSTCL
HCVCKSTCL
p

65,2 ± 12,7
65,7 ± 12,3
0,82


74,5 ± 19,4
73,6 ± 18,0
0,79

57,52 ± 10,79
65,69 ± 7,98
<0,001
NT-proBNP
1928,7
499,2
<0,001
GRACE
168,5 ± 30,4
118,6 ± 28,9
<0,001
B3.--IV

N

NT-proBNP (pg/ml)
n (%)
OR (95% KTC)
p
Trung bình
p
Killip I
103
3 (2,9)
6,67
(1,38-32,11)

0,024
792,0
<0,001
Killip II-IV
24
4 (16,7)
3964,3



(p <0,001)
r = -0,503 (p <0,001)
3.1. So sánh NT-

3.-proBNP

3.-n suy tim sau HCVC




AUC
p
NT-proBNP (pg/ml)
>1007
79,2%
60,4%
0,751
<0,001
>1815

50,0%
76,0%
 3.-

NT-proBNP



>2037 pg/ml
100%
76,7%
>3957 pg/ml
85,7%
90,0%
 
>1788 pg/ml
100%
73,3%
>3957 pg/ml
63,6%
90,5%
3.-
nhân HCVC




AUC
p
NT-proBNP (pg/ml)

>2037
100%
76,7%
0,917 (0,86-0,96)
<0,001

>170
71,4%
85,0%
0,836 (0,76-0,90)
0,003
-

GRACE + NT-proBNP= (3 x GRACE) + (3997 x log NT-proBNP)
3.-proBNP




AUC
p
GRACE + NT-proBNP
>13779,3
100%
78,3%
0,920
(0,86-0,96)
<0,001
>15233,5
71,4%

92,5%


-
-

   -  [5] 
-proBNP là 545 pmol/L (157-1435 pmol/L) [8].
-

 
(OR= 4,6; 95% KTC= 3,85-   - 
-
II-IV) sau HCVC, 3964,3 pg/ml
[9]
--
[8].
-
   -proBNP
 là 809,7
--44%) là 2851,2 pg/ml (p
Estrada và cs n
-49%), trung bình (EF 30-
      -proBNP là 170,2 pg/ml, 333,7 pg/ml, 600,4
pg/ml và 1439,4 pg/ml (p <0,0001) [1]          -
 -54%, 40-49% và <40%) là
1123 pg/ml, 1394 pg/ml, 2170 pg/ml và 2564 pg/ml (p= 0,02) [2].
-

      -        r= -0,509; p

<0,001) [11]. The--
0,49 (p< 0,004) [6]-
-0,503; p <0,001).
-
 

NT-[7]
-proBNP là 2827 pg/ml [4]
0,80 và p <0,001) [10].

      
[3], Khan (AUC=
0,84 và p <0,001) [5], Timóteo (AUC= 0,85 và p <0,001) [10] và chúng tôi (AUC= 0,84 và p=
-

-
-
,85-0,90; p <0,001) [5]

NT--0,90) và 0,86 (0,81-0,91) [10]
                
GRACE + NT-proBNP là 0,920 (95% KTC= 0,86-0,96) và p <0,001.
-proBNP >2037 pg/ml giúp tiên
-



-

-

-
30-               -
-0,503; p <0,001).
-

0,917 (p <0,001).

+ NT-proBNP = (3 x GRACE) + (3.997 x log NT- 



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