STEMI患者NT-proBNP水平对急诊直接PCI后ST段回落的预测能力

发布时间：2018-04-22 15:53

本文选题：急性心肌梗死 + ST段回落　；参考：《广东医学》2017年20期

【摘要】：目的评估入院时急性ST段抬高型心肌梗死(STEMI)患者的血清氨基末端脑钠肽前体(NTpro BNP)水平对急诊/直接PCI(p PCI)后ST段回落(STR)的预测能力。方法连续入选住院并接受p PCI的218例STEMI患者,依据术后180 min位点上STR,分成STR良好组(≥50%)和STR不良组(50%),随访12个月,观察主要不良心脏事件,对两组间的基线临床特点、手术资料、心脏标志物逐一比较及筛检,经单因素、多变量逻辑回归分析等处理,明确STR不良的预测因子。结果在p PCI术后180 min的研究位点上,202例(92.7%)患者STR良好,回落不良者为16例(占7.3%)。单因素分析提示,较之STR良好组,STR不良组患者的左室射血分数低[(56.5%±3.0%)vs(58.7%±3.6%),P=0.019]、左室舒张末期内径大[(53.1±2.7)mm vs(50.6±2.9)mm,P=0.019]、糖化血红蛋白高[(6.9%±2.1%)vs(5.6%±1.3%),P=0.034]、血清NT-pro BNP水平高[(4 476.2±1784.9)pg/m L vs(2 505.6±1 638.4)pg/m L,P0.001]。多变量逐步回归分析显示,血清NT-pro BNp水平是STEMI患者接受p PCI术后STR不良唯一的独立预测因子(OR=3.368,95%CI:3.152~4.643,P=0.004)。NT-pro BNP的ROC下面积为0.814。NT-pro BNP≥2 563.60 pg/m L预测STR不良的敏感度为81.2%,特异度为65.8%。结论入院时血清NT-pro BNp水平对STEMI患者p PCI术后STR不良具有良好的预测价值。以NT-pro BNP为指导的策略有助于识别STR不良的高危STEMI患者,能在p PCI前为临床医师提供更多有用的临床信息。
[Abstract]:Objective to assess the predictive ability of the serum amino terminal natriuretic peptide precursor (NTpro BNP) level in patients with acute ST segment elevation myocardial infarction (STEMI) to the prediction of ST segment decline (STR) after emergency / direct PCI (P PCI). Methods 218 cases of STEMI patients admitted to the hospital and accepted p PCI were divided into a good group (> 50%) according to the postoperative 180 locus. The poor group of STR (50%) was followed up for 12 months. The main adverse cardiac events were observed. The baseline clinical features, the surgical data, the cardiac markers were compared and screened in the two groups. The undesirable predictive factors of STR were determined by single factor and multivariate logistic regression analysis. On the study site of 180 min after P PCI, 202 cases (92.7%) were ST. R was good, with 16 cases (7.3%). Single factor analysis suggested that the left ventricular ejection fraction of patients with STR was lower than that of STR group (56.5% + 3%) vs (58.7% + 3.6%), P=0.019], large [53.1 + 2.7) mm vs (50.6 + 2.9) mm, P= 0.019], high glycated hemoglobin [(6.9% + 2.1%) vs (5.6% + 1.3%), P=0.034], serum The level of O BNP was high [(4476.2 + 1784.9) pg/m L vs (2505.6 + 1638.4) pg/m L, and P0.001]. multivariable stepwise regression analysis showed that the serum NT-pro BNp level was the only independent predictor for STEMI patients after accepting P. The adverse sensitivity of STR was 81.2%. The specificity was 65.8%. conclusion that the level of serum NT-pro BNp was of good predictive value for STR poor after P PCI in STEMI patients. The strategy guided by NT-pro BNP was helpful to identify high-risk STEMI patients with poor STR and to provide more useful clinical information for clinical physicians.

【作者单位】：郑州大学附属郑州中心医院心内科;河南医学高等专科学校病理生理学教研室;
【基金】：河南省教育厅科学技术研究重点项目(编号:14B310002)
【分类号】：R542.22

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