摘要
目的 探讨血清肌酐(Scr)、高敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽原(NT-proBNP)与烧伤患者院内主要心血管不良事件(MACE)的相关性及其预测价值.方法 回顾性收集254例烧伤患者作为研究对象.根据住院期间是否发生MACE,分为MACE组(85例)和非MACE组(169例),比较2组临床基线资料和实验室指标水平,采用受试者操作特征(ROC)曲线评价Scr、hs-cTnT、NT-proBNP对烧伤患者院内并发MACE的预测价值.结果 与非MACE组相比,MACE组患者年龄、烧伤总面积、Scr、hs-cTnT、NT-proBNP、胱抑素C水平更高(P均＜0.05),同时2组性别、高血压病史、脓毒血症、吸烟史比较差异均有统计学意义(P均＜0.05).多因素分析显示,Scr、hs-cTnT、NT-proBNP是烧伤患者院内MACE的独立危险因素(P均＜0.05).ROC曲线分析显示,Scr、hs-cTnT、NT-proBNP及三者联合预测MACE的曲线下面积(AUC)值分别为0.743、0.802、0.733、0.801.DeLong检验显示,三者联合预测MACE的AUC值高于Scr单独预测(Z=2.897,P=0.003);Scr、hs-cTnT、NT-proBNP三者单独预测MACE两两比较差异均无统计学意义(Z值分别为1.398、0.202、1.900,P值分别为0.162、0.840、0.057).亚组分析显示,hs-cTnT≥0.0145 p.g/L 组烧伤患者 MACE 发生率高于 hs-cTnT＜0.0145 μ g/L 组(P＜0.05).Spearman 秩相关分析显示,hs-cTnT水平与烧伤严重程度呈正相关(P＜0.05).结论 Scr、hs-cTnT、NT-proBNP是烧伤患者院内MACE的独立危险因素且具有良好的预测价值,hs-cTnT水平与烧伤患者严重程度相关.
Abstract
Objective To investigate the correlation between serum creatinine(Scr),high-sensitivity troponin T(hs-cTnT),N-terminal pro-B-type natriuretic peptide(NT-proBNP),and in-hospital major adverse cardiovascular events(MACE)in burn patients and evaluate their predictive value.Methods In this retrospective study,254 burn patients were enrolled and divided into the MACE group(n=85)and non-MACE group(n=169)according to whether MACE occurred during hospital stay.Clinical baseline data and laboratory indexes were statistically compared between the two groups.The predictive values of Scr,hs-cTnT,and NT-proBNP for in-hospital MACE in burn patients were assessed by the receiver operating characteristic(ROC)curve.Results Compared with the non-MACE group,older age,larger total area of burns,and higher levels of Scr,hs-cTnT,NT-proBNP,and cystatin C were observed in the MACE group(all P＜0.05).There were significant differences in gender,history of hypertension,sepsis,and smoking history between the two groups(all P＜0.05).Multivariate analysis showed that Scr,hs-cTnT,and NT-proBNP were the independent risk factors for nosocomial MACE in burn patients(all P＜0.05).The area under the curve(AUC)values of Scr,hs-cTnT,NT-proBNP,and their combined prediction of MACE were 0.743,0.802,0.733,and 0.801 by ROC curve analysis.According to the DeLong test results,the AUC value of MACE predicted by the three combined was more significant than the value indicated by Scr alone(Z value=2.897,P=0.003).The predictive value of Scr,hs-cTnT,and NT-proBNP for MACE was not significantly different(Z values were 1.398,0.202,and 1.900,and P values were 0.162,0.840,and 0.057,respectively).Subgroup analysis showed that the incidence of MACE in burn patients in the hs-cTnT≥0.014 5 µ g/L group was higher than in their counterparts in the hs-cTnT＜0.014 5 p g/L group(P＜0.05).Spearman correlation analysis showed a positive correlation between hs-cTnT level and the severity of burns(P＜0.05).Conclusions Scr,hs-cTnT,and NT-proBNP are the independent risk factors for nosocomial MACE in burn patients and have good predictive values.In addition,hs-cTnT level is correlated with the severity of burns.
国家科技期刊平台
NSTL
维普
万方数据