摘要
目的:探讨那不勒斯预后评分(Naples prognostic score,NPS)对非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)合并慢性肾脏病(chronic kidney disease,CKD)患者行PCI术后预后的预测价值。方法:回顾性纳入2018年至2020年在首都医科大学附属北京安贞医院接受PCI术的565例NSTE-ACS合并CKD患者(排除CKD4~5期)。根据NPS评分将患者分为3组。随访3年,主要终点事件为主要不良心血管事件(major adverse cardiovascular events,MACE),次要终点事件包括全因死亡、非致死性心肌梗死(myocardial infarction,MI)和再次血运重建。采用Kaplan-Meier生存分析、受试者工作特征(receiver operating characteristic,ROC)曲线、多因素COX比例风险回归模型及亚组分析评估NPS与预后的关系。结果:随着NPS评分升高,MACE发生率逐渐增加(第3组vs.第2组vs.第1组:43.8%vs.36.3%vs.18.9%,P=0.010)。Kaplan-Meier分析显示NPS评分较高组MACE、全因死亡和再次血运重建风险显著增加(Log-rank P<0.05)。ROC曲线分析显示NPS对MACE具有中等预测能力(area under curve,AUC=0.658,P<0.001)。多因素COX回归分析证实,NPS评分升高是MACE(HR=1.33,95%CI:1.15~1.53,P<0.001)、全因死亡(HR=1.30,95%CI:1.04~1.62,P=0.019)和TVR(HR=1.51,95%CI:1.19~1.91,P=0.001)的独立危险因素。亚组分析结果表明NPS与MACE的关系在性别(P交互=0.025)和CKD分期(P交互<0.001)亚组间存在差异。结论:NPS可独立预测NSTE-ACS合并CKD患者PCI术后MACE、全因死亡和再次血运重建风险,其预测效能在不同性别和CKD分期亚组中存在差异。
Objective:To investigate the prognostic value of Naples prognostic score(NPS)in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)and chronic kidney disease(CKD)after coronary stent implantation.Methods:A retrospective study was conducted on 565 NSTE-ACS patients with CKD(excluding CKD stages 4-5)who underwent successful coronary stent implantation at Beijing Anzhen Hospital,Capital Medical University,between 2018 and 2020.Patients were stratified into three groups based on NPS scores.During a 3-year follow-up,the primary endpoint was major adverse cardiovascular events(MACE),and secondary endpoints included all-cause mortality,non-fatal myocardial infarction(MI),and repeat revascularization.The relationship between NPS and prognosis was evaluated using Kaplan-Meier survival analysis,receiver operating characteristic(ROC)curve,multivariate COX proportional hazards regression model,and subgroup analyses.Results:MACE incidence increased progressively with higher NPS scores(Group 3 vs.Group 2 vs.Group 1:43.8%vs.36.3%vs.18.9%,P=0.010).Kaplan-Meier analysis demonstrated that patients with higher NPS scores had significantly increased risks of MACE,all-cause mortality,and repeat revascularization(Log-rank P<0.05).ROC curve analysis showed moderate predictive ability of NPS for MACE(AUC=0.658,P<0.001).Multivariate Cox regression analysis confirmed that elevated NPS was an independent risk factor for MACE(HR=1.33,95%CI:1.15-1.53,P<0.001),all-cause mortality(HR=1.30,95%CI:1.04-1.62,P=0.019),and repeat revascularization(HR=1.51,95%CI:1.19-1.91,P=0.001).Subgroup analyses revealed significant interactions between NPS and MACE across gender(P interaction=0.025)and CKD stages(P interaction<0.001).Conclusions:NPS independently predicts the risk of MACE,all-cause mortality,and repeat revascularization in NSTE-ACS patients with CKD after coronary stent implantation,with varying predictive efficacy across gender and CKD stage subgroups.
作者
谢佳宏
鲜中
朱昱睿
周泽恺
蒋宏峰
XIE Jiahong;XIAN Zhong;ZHU Yurui;ZHOU Zekai;JIANG Hongfeng(The Fifth Ward of The Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2025年第6期553-560,共8页
Journal of Cardiovascular and Pulmonary Diseases
基金
国家自然科学基金面上项目(81970392)。
关键词
那不勒斯预后评分
非ST段抬高型急性冠状动脉综合征
慢性肾脏病
冠状动脉介入术
主要不良心血管事件
心肌梗死
Naples Prognostic Score
Non-ST-segment elevation acute coronary syndrome
Chronic kidney disease
Percutaneous coronary intervention
Major adverse cardiovascular event
Myocardial infarction
