急性心肌梗死患者血清N末端B型钠尿肽检测在左室重构中的预测价值

Predictive value of serum N-tenninal pro-brain natriuretic peptide in acute myocardial infarction patients for left ventricular remodeling

目的观察AMI患者发病第3天血清NT-proBNP水平与其左室重构之间的关系,评价其对AMI后左室重构的预测价值。方法以急性心肌梗死(AMI)发病第3天与3个月时患者的左心室舒张末期内径之差(△LVDd)>5 mm以及发病3个月时左心室射血分数(LVEF)≤40％作为发生心脏左室重构的依据。采用免疫电化学发光法测定106例患前壁、前间壁及前侧壁AMI的患者第3天血清NT-proBNP水平,分别对患者第3天和3个月时行超声心动描述术检测LVDd和LVEF水平。结果AMI患者第3天血清NT-proBNP均值是1039．28(241．50～1184．25)ng／L。AMI患者第3天和3个月时LVDd由(50±5)mm升至(53±7)mm(P<0．05),LVEF由(53±8)％升高为(54±11)％(P>0．05)。AMI后第3天NT-proBNP浓度与△LVDd呈显著正相关r=0．403(P<0．05),与LVEF呈显著负相关r=-0．395(P<0．01);ROC曲线分析表明以AMI发病3个月间△LVDd>5 mm作为发生左室重构的依据,曲线下面积(AUC)为0．894;以AMI发病3个月时LVEF≤40％作为发生左室重构的依据,则AUC为0．873;以AMI发病3个月间ALVDd>5 mm和3个月时LVEF≤40％作为发生左室重构的依据,则AUC为0．893。结论AMI患者第3天血清NT-proBNP水平可作为预测AMI晚期的左室重构指标之一。

Objective To evaluate the forecasting capability of serum N-terminal pro-brain natriuretic peptide （NT-proBNP） level for Left ventricular （LV） remodeling of patients with acute myocardial infarction （AMI） through observation of the relationship between serum NT-proBNP on the 3rd day and LV remodeling following onset of AMI. Methods Electrochemilumin-escence was adopted to determine the serum NT-proBNP level on the 3rd day after AMI attack for 106 cases of patients with anterior, anteroseptal and anterolateral AMI, with echocardiography performed to detect LV end-diastolic diameter （LVDd） and lefiventricular ejection fraction （LVEF） respectively on the 3rd day and 3 months after the attack. Results The serum NT-proBNP level of AMI patients on the 3rd day averaged 1039. 28 （ 241.50- 1 184. 25） ng/L. For AMI patients on the 3rd day and 3 months after, LVDd rose to （53 ±7） mm （P 〈 0.05） from （50 ±5） mm, and LVEF to （54 ± 11） % （P〉0.05） from （53±8） %. NT-proBNP concentration on the 3rd day after AMI onset was positively correlated with △LVDd significantly,r = 0. 403 （ P 〈 0. 05 ） , while negatively correlated with LVEF significantly, r = - 0. 395 （ P 〈 0. 01 ）. Analysis by ROC curve showed that if LV remodeling was decided when ALVDd （ 5ram during the 3 months after AMI onset, AUC （ area under ROC curve） was 0. 894, if decided when LVEF ≤40 % at the 3rd month after the onset, AUC was 0. 873, and if decided when △LVDd 〉 5ram during the 3 months and LVEF at the 3rd month ≤〈40 % , AUC was 0. 893. Conclusion The test results showed serum NT-proBNP level for AMI patients on the 3rd day may be used as one of forecasting indexes of LV remodeling for AMI of advanced stage.