不同部位AMI患者发病48h内血浆BNP水平变化及其对近期并发心力衰竭的预测价值

发布时间：2019-04-08 15:05

【摘要】：目的观察不同部位急性心肌梗死(AMI)患者发病48 h内血浆脑钠肽(BNP)水平变化,并探讨其对住院期间并发心力衰竭(HF)的预测价值。方法发病12 h内行急诊经皮冠状动脉介入治疗的AMI患者70例,按照心梗发生部位不同分为前壁组41例和非前壁组29例,比较术后1 h内及发病12、20、24、48 h(分别计为T_1~T_5)血浆BNP;记录患者住院期间HF发生情况,通过绘制受试者工作特征曲线(ROC曲线)确定各时点BNP对AMI患者住院期间并发HF的预测价值。结果与非前壁组比较,前壁组T_1~T_4时点血浆BNP水平升高;与同组T_1时点比较,两组T_2~T_5时点血浆BNP水平升高;与同组T_2时点比较,两组T_3、T_4时点血浆BNP水平升高;与同组T_3、T_4时点比较,两组T_5时点血浆BNP水平降低;P均0.05。ROC曲线分析显示,前壁组T_1~T_5时点BNP水平预测AMI住院期间并发HF的曲线下面积(AUC)分别为0.800、0.831、0.831、0.835、0.885,其中T_5时点AUC最大,此时BNP预测HF的最佳分界值为169.6 pg/mL,灵敏度和特异度分别为92.3%、70.0%;非前壁组在T_1~T_5时点BNP水平预测住院期间并发HF的AUC分别为0.653、0.801、0.847、0.784、0.761,其中T_3时点AUC最大,此时BNP预测HF的最佳分界值为178.5 pg/mL,灵敏度和特异度分别为100.0%、68.7%。结论前壁和非前壁AMI发病48 h内BNP水平呈现先快速升高后缓慢下降的单峰趋势,达峰时间在发病20~24 h;不同部位AMI各时间点血浆BNP水平对AMI住院期间并发HF预测价值不同,发病48 h血浆BNP水平对前壁并发HF的预测价值最高,发病20 h血浆BNP水平对非前壁并发HF的预测价值最高。
[Abstract]:Aim to observe the changes of plasma levels of brain natriuretic peptide (BNP) in patients with acute myocardial infarction (AMI) within 48 hours after onset of acute myocardial infarction (AMI), and to evaluate the predictive value of brain natriuretic peptide (BNP) in patients with heart failure during hospitalization. Methods 70 AMI patients who underwent emergency percutaneous coronary intervention (PCI) within 12 hours of onset were divided into anterior group (n = 41) and non-anterior group (n = 29) according to the location of myocardial infarction. The plasma BNP; was compared within 1 hour after operation and 12, 20, 24, 48 hours after operation (T_1~T_5, respectively). The occurrence of HF during hospitalization was recorded, and the predictive value of BNP at each time point to HF in patients with AMI during hospitalization was determined by drawing the receiver operating characteristic curve (ROC curve). Results compared with the non-anterior group, the plasma BNP level in the anterior wall group was higher than that in the control group at the time of T_1~T_4, and the plasma BNP level at the time point of T_2~T_5 in the two groups was higher than that in the same group at 1 hour. Compared with the same group, the levels of plasma BNP in the two groups increased at 2 and 4 hours, and the plasma BNP levels in the two groups decreased at 5 hours as compared with those in the same group at 2 and 4 hours, and at the same time, the levels of plasma BNP in the two groups were significantly higher than those in the other two groups at 2 and 4 hours, respectively. P-all 0.05.ROC curve analysis showed that the BNP level at the time point of T_1~T_5 in the anterior wall group predicted the area (AUC) under the curve of AMI complicated with HF during hospitalization was 0.800, 0.831, 0.831, 0.835, 0.885, respectively. Among them, the AUC at 5 h was the largest. The optimal threshold for HF prediction by BNP was 169.6 pg/mL, sensitivity and specificity of 92.3% and 70.0%, respectively. The levels of BNP in the non-anterior wall group predicted the AUC of HF during hospitalization was 0.653, 0.801,0.847, 0.784, 0.761, respectively, and the AUC was the largest at the time of T_1~T_5. At this time, the optimal threshold value of BNP to predict HF was 178.5 pg/mL,. The sensitivity and specificity were 100. 0% and 68. 7%, respectively. Conclusion the level of BNP in the anterior wall and non-anterior wall of AMI showed a single peak trend in 48 hours after onset, and the peak time was at 20 hours after onset and then decreased slowly. The predictive value of plasma BNP level at different time points for AMI complicated with HF was different at different time points of AMI. Plasma BNP level at 48 h after onset had the highest predictive value for anterior wall complicated HF, and plasma BNP level at 20 h had the highest predictive value for non-anterior wall complicated with HF.
【作者单位】：南方医科大学;广州军区广州总医院;南方医科大学珠江医院;
【基金】：广东省信息产业发展专项基金(粤经信[2014]975号) 广州市科技计划专项(2014Y2-00068);广州市科技计划产学研专项(201508020043) 广州市重点实验室建设专项(穗科信字[2013]163-15号)
【分类号】：R541.6;R542.22

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