N端脑钠肽前体对急性心肌梗死并发脑梗死的预测价值

Prediction of cerebral infarction in patients with acute myocardial infarction by N-terminal pro-B-type natriuretic peptide

目的探讨N端脑钠肽前体(NT-proBNP)对急性心肌梗死(acute myocardial infarction,AMI)患者并发脑梗死的预测作用。方法回顾分析了445例AMI患者的临床资料,全部患者均在首次胸痛24 h内测定血浆NT-proBNP水平。通过受试者工作曲线(receiver operating characteristic curve,ROC)分析NT-proBNP预测脑梗死发生的价值及界值,并通过Logistic回归分析比较NT-proBNP的独立预测价值。结果AMI后1年内共有29例患者并发脑梗死。脑梗死组发病24 h内血浆NT-proBNP水平明显高于无脑梗死组(P<0.05)。ROC曲线显示NT-proBNP有可能预测脑梗死的发生。根据ROC曲线定1082 ng/L为最佳分界值时,预测AMI患者并发脑梗死的敏感性、特异性、准确度、阳性和阴性预测值分别为50.0%、96.8%、84.3%、52.1%、96.5%。Logistic回归分析显示NT-proBNP水平﹥1082 ng/L是AMI并发脑梗死的独立危险因素。结论发病24 h内血浆NT-proBNP水平﹥1082 ng/L的AMI患者易并发脑梗死。

Objective To explore the predictive value of N-terminal pro-B-type natriuretic peptide （NT-proBNP） for the incidence of cerebral infarction in patients with acute myocardial infarction （AMI）. Methods Clinical data of 445 patients with AMI were analyzed retrospectively. The plasma concentration of NT-proBNP was determined within 24 h after onset of chest pain. The receiver operating characteristic curve （ROC） was drawn to determine the predictive value of NT-proBNP for the incidence of cerebral infarction in patients with AMI and the logistic regression models were used to evaluate the prognostic contribution of NT-proBNP. Results Twenty-nine patients had cerebral infarction 1 year after AMI. Plasma NT-proBNP in the first 24 h following AMI was significantly higher in cerebral in- farction group than in non-cerebral infarction group. The ROC curve showed that NT-proBNP could predict the incidence of cerebral infarction after AMI. The cut off point value of NT-proBNP determined according to ROC curve was 1082 ng/L. The sensitivity, specificity, accuracy, positive and negative predictive values for the incidence of cerebral infarction was 50.0% ,96.8%,84.3% ,52.1% ,96.5%, respectively. Furthermore, the logistic regression showed that NT-proBNP concentration （〉1082 rig/L） was the independent predictor of the incidence of cerebral infarction after AMI. Conclusions Patients with plasma NT-proBNP （〉1082 ng/L） in the first 24 h following AMI have a high risk of cerebral infarction.