>[0218] 表 7
[0219]
[0220] 使用70pg/ml的簡早的截止值分機(jī)，通]3： AUM簽足J 89. 5%的所有在ED就診時需 要血管加壓劑的患者（第2組）。有20名患者>70pg/ml在就診時不具有血管加壓劑需要 (組1/3)，有15名（75% )在4天的隨后期間未產(chǎn)生血管加壓劑需要，并且有5名（25% ) 患者在4天的隨后期間產(chǎn)生血管加壓劑需要。相反，如果在就診時無血管加壓劑需要的患 者ADM為<70pg/ml (組1/3)，56名（96. 5% )在4天的隨后期間未產(chǎn)生血管加壓劑需要，并 且僅2名（3. 5% )產(chǎn)生血管加壓劑需要。具有大于70pg/ml的ADM值的患者在接下來的4 天產(chǎn)生血管加壓劑需要的風(fēng)險(xiǎn)為具有小于70pg/ml的ADM水平的患者的7. 1倍高（25%相 對于3. 5% )。
[0221] 因?yàn)橐恢北O(jiān)測血壓，從臨床觀點(diǎn)而言，在就診時具有高ADM(>70pg/ml)而無血管 加壓劑需要的患者應(yīng)當(dāng)通過將決定點(diǎn)從<66mmHg MAP調(diào)整至例如<75mmHg來進(jìn)行血管加壓 劑治療，旨在盡早支持循環(huán)，從而保護(hù)患者免于低血壓相關(guān)的器官功能障礙和隨后的高死 亡率。使用這一規(guī)則，對于>70pg/ml ADM且在MAP〈 = 75mmHg下用血管加壓劑治療的患者， 患者（第3組）將在標(biāo)準(zhǔn)的護(hù)理治療（〈=66mmHg)前治療平均1. 6天。
[0222] 當(dāng)在分析中使用具有0. 78noml/L的臨界值的MR-proADM而非ADM時，獲得了類似 的結(jié)果。
[0223] 表 8
[0224]
[0225] 實(shí)施例8
[0226] 臨床研究/急性心力衰竭
[0227] 募集的患者為進(jìn)入急診科的患急性心力衰竭的患者。患者特征：均值土SD年齡 74. 3±12. 2y ;n = 1022(643名男性，63% );先前的缺血性心臟病31%，高血壓58%，糖尿 病33%，心力衰竭35%?；颊唠S訪2年。在入院當(dāng)天獲得用于測量ADM和其他分析物的血 漿樣本。
[0228] Cox分析揭示出ADM為1年死亡（表9)和由于急性失代償型心力衰竭的1年死亡 /住院治療（表10)的獨(dú)立預(yù)測因子。邏輯回歸分析揭示出ADM為院內(nèi)死亡的獨(dú)立預(yù)測因 子（表11)。
[0229] 需要血管加壓劑治療（強(qiáng)心劑）的患者具有顯著高于所有其他患者的ADM濃度 (曲線下面積=0· 75 ;p〈0001 ;圖7)。
[0230] 表 9
[0231]
[0232] 表 10
[0233]
[0234] 表 11
[0235]
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