目的: 探讨血清N-端脑利钠肽前体（NT-proBNP）、超敏肌钙蛋白（hs-cTnI）、胱抑素C（CysC）与急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）后发生HF的相关性。方法: 选取2020年1月―2022年1月广安市人民医院行PCI术治疗的154例AMI患者（AMI组）,根据PCI术后6个月HF发生情况将其分为HF组28例和非HF组126例,另选取同期77例健康体检者（HC组）。比较AMI组和HC组血清NT-proBNP、hs-cTnI、CysC水平;比较AMI患者PCI术后HF组与非HF组临床特征及三种血清指标水平;Pearson相关性分析AMI患者PCI术后HF组血清NT-proBNP、hs-cTnI、CysC水平的关系;Logistic回归分析影响AMI患者PCI术后并发HF的相关危险因素;ROC分析血清NT-proBNP、hs-cTnI、CysC与AMI患者PCI术后发生HF的诊断价值。结果: AMI组血清NT-proBNP、hs-cTnI、CysC水平高于HC组;HF组与非HF组年龄、发病至入院时间、冠脉病变支数、Gensini评分、LVEF、Tei指数和CK-MB水平差异显著;HF组三种血清指标水平高于非HF组;Pearson相关性分析,HF组血清NT-proBNP、hs-cTnI、CysC水平间呈正相关;Logistic回归分析,年龄、Gensini评分和上述三种血清指标水平为影响PCI术后并发HF的因素;ROC分析,血清NT-proBNP、hs-cTnI、CysC水平诊断AMI患者PCI术后HF的AUC分别为0.878、0.732和0.710,联合诊断AMI患者PCI术后HF的AUC为0.889,灵敏度、特异度分别为94.74%和75.76%。结论: 血清NT-proBNP、hs-cTnI、CysC水平与AMI患者PCI术后发生HF存在密切的相关性,且各指标间存在正相关。
Abstract
Objective To explore the correlation between serum N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive cardiac troponin (hs-cTnI), cystatin C (CysC) and heart failure (HF) in acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods A total of 154 patients with AMI undergoing PCI in Guang’an People's Hospital were enrolled as AMI group between January 2020 and January 2022. According to presence or absence of HF at 6 months after PCI, they were divided into HF group (28 cases) and non-HF group (126 cases). A total of 77 healthy controls (HC) during the same period were enrolled as HC group. The levels of serum NT-proBNP, hs-cTnI and CysC between AMI group and HC group, as well as the clinical characteristics and levels of serum NT-proBNP, hs-cTnI and CysC between HF group and non-HF group were compared. The relationship among serum NT-proBNP, hs-cTnI and CysC was analyzed by Pearson correlation analysis. The risk factors of HF were analyzed by Logistic regression analysis. The diagnostic value of NT-proBNP, hs-cTnI and CysC for HF was analyzed by receiver operating characteristic (ROC) curves. Results The levels of serum NT-proBNP, hs-cTnI and CysC in AMI group were higher than those in HC group. There were significant differences in age, interval from onset to admission, number of coronary lesions, Gensini score, LVEF, Tei index and CK-MB between HF group and non-HF group. The levels of serum NT-proBNP, hs-cTnI and CysC in HF group were higher than those in non-HF group. Pearson correlation analysis showed that levels of serum NT-proBNP, hs-cTn and CysC were positively correlated. Logistic regression analysis showed that age, Gensini score, NT-proBNP, hs-cTnI and CysC were all influencing factors of HF. ROC curves analysis showed that AUC values of serum NT-proBNP, hs-cTnI and CysC in the diagnosis of HF were 0.878, 0.732 and 0.710, respectively. AUC, sensitivity and specificity of combined detection were 0.889, 94.74% and 75.76%, respectively. Conclusion The levels of serum NT-proBNP, hs-cTnI and CysC are closely related to HF in AMI patients after PCI, and the three indexes are correlated.
关键词
N-端脑利钠肽前体 /
高敏肌钙蛋白 /
胱抑素C /
急性心肌梗死 /
心力衰竭
Key words
N-terminal pro-brain natriuretic peptide /
high-sensitive cardiac troponin /
cystatin C /
acute myocardial infarction /
heart failure
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参考文献
[1] Edupuganti MM, Ganga V.Acute myocardial infarction in pregnancy: Current diagnosis and management approaches[J]. Indian Heart J, 2019, 71(5): 367-374.
[2] Al-Lamee RK, Nowbar AN, Francis DP.Percutaneous coronary intervention for stable coronary artery disease[J]. Heart, 2019, 105(1): 11-19.
[3] Parikh PB, Bhatt DL, Bhasin V, et al.Impact of percutaneous coronary intervention on outcomes in patients with heart failure: jacc state-of-the-art review[J]. J Am Coll Cardiol, 2021, 77(19): 2432-2447.
[4] Lee SE, Lee HY, Cho HJ, et al.Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure[J]. Heart, 2020, 106(1): 50-57.
[5] 任艳琴, 赵凯华, 高胜利, 等. 降钙素原联合N末端脑钠肽前体预测急性ST段抬高型心肌梗死PCI术病人预后的临床价值[J]. 中西医结合心脑血管病杂志, 2021, 19(8): 1349-1352.
[6] Ezekowitz JA, O'Connor CM, Troughton RW, et al. N-terminal pro-b-type natriuretic peptide and clinical outcomes: vericiguat heart failure with reduced ejection fraction study[J]. JACC Heart Fail, 2020, 8(11): 931-939.
[7] Yao Z, Li G, Li G.Correlation between serum urea nitrogen, cystatin C, homocysteine, and chronic heart failure[J]. Am J Transl Res, 2021, 13(4): 3254-3261.
[8] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 《中国循环杂志》编辑委员会. 急性心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2001, 29(12): 710-725.
[9] 颜红兵, 胡大一. 解读美国心脏病学学院和美国心脏协会2013年心力衰竭治疗指南[J]. 中华心血管病杂志, 2013, 41(12): 1069-1071.
[10] Tehrani BN, Basir MB, Kapur NK.Acute myocardial infarction and cardiogenic shock: Should we unload the ventricle before percutaneous coronary intervention?[J]. Prog Cardiovasc Dis, 2020, 63(5): 607-622.
[11] 李强, 胡强, 孙笑然, 等. 球囊后扩张对急性心肌梗死患者直接经皮冠状动脉介入术影响研究[J]. 临床军医杂志, 2021, 49(5): 507-513.
[12] 胡强, 韩雪松, 李智佳, 等. 经皮冠状动脉介入术治疗后青年急性心肌梗死患者住院时间延长影响因素分析[J]. 临床军医杂志, 2021, 49(12): 1298-1301.
[13] Wang C, Gao Y, Tian Y, et al.Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide[J]. Br J Anaesth, 2021, 127(6): 862-870.
[14] Wang C, Han S, Tong F, et al.Predictive value of the serum cystatin c/prealbumin ratio in combination with nt-probnp levels for long-term prognosis in chronic heart failure patients: a retrospective cohort study[J]. Front Cardiovasc Med, 2021, 14(8): 684-685.
[15] 刘宇娜, 张丽, 赵蕾, 等. NT-proBNP, MYO, cTnI对急性心肌梗死PCI后预后评估中的价值[J]. 中华保健医学杂志, 2022, 24(1): 4-6.
[16] Castiglione V, Aimo A, Vergaro G, et al.Biomarkers for the diagnosis and management of heart failure[J]. Heart Fail Rev, 2022, 27(2): 625-643.
[17] Jin S, Xu J, Shen G, Gu P.Predictive value of circulating cystatin C level in patients with acute coronary syndrome: a meta-analysis[J]. Scand J Clin Lab Invest, 2021, 81(1): 1-7.
[18] Sa MPBO, Perazzo AM, Saragiotto FAS, et al.Coronary artery bypass graft surgery improves survival without increasing the risk of stroke in patients with ischemic heart failure in comparison to percutaneous coronary intervention: a meta-analysis with 54, 173 patients[J]. Braz J Cardiovasc Surg, 2019, 34(4): 396-405.
[19] 王娜, 左艳芳, 李宗赢, 等. 急性心肌梗死行急诊PCI后发生射血分数保留性心力衰竭的危险因素及预后分析[J]. 中国循证心血管医学杂志, 2020, 12(9): 1122-1124+1128
[20] 张雷, 刘江萍, 木胡牙提, 等. 急性冠状动脉综合征不同亚型的危险因素分析[J]. 中国心血管病研究, 2019, 17(11): 983-988.
基金
四川省转移支付项目（2021ZYZFSY01）
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