N末端B型利钠肽原对急诊经皮冠状动脉介入术后无复流的预测价值

Prognostic significance of admission N-terminal pro-brain natriuretic peptide in predicting angiographic no-reflow phenomenon during percutaneous coronary intervention in patients with acute myocardial infarction

目的探讨急性心肌梗死患者入院N末端B型利钠肽原（NT-proBNP）水平与急诊经皮冠状动脉（简称冠脉）介入治疗术后无复流现象的关系。方法入选接受急诊PCI治疗的急性心肌梗死患者106例。检测入院时NT—proBNP以及肌钙蛋白I、超敏c反应蛋白等生物标志物。依据入院时NT—proBNP水平将患者分为NT-proBNP正常组（≤400ng／L）和NT-proBNP升高组（〉400ng／L）。根据冠脉造影血流TIMl分级，将患者分为冠脉血流正常组（TIMl分级=3）和无复流组（TIMl分级≤2）。比较两组间各项生物标志物以及临床特征的差异。以ROC曲线计算NT—proBNP预测无复流发生的阈值，采用多因素Logistic回归分析急诊PCI术后无复流发生的危险因素。结果NT—proBNP升高组患者中无复流的发生率明显高于NIT-proBNP正常组（16．6％比3。6％，P〈0．05）。无复流组患者入院NT—proBNP水平明显高于冠脉血流正常组[1883ng／L（484—5500ng／L）比220ng／L（87～926ng／L）P=0．046]。入院NT．proBNP〉1765ng／L是急性心肌梗死PCI术后冠脉造影无复流的独立危险因素（OR=10．3，95％CI1．49～70．65，P=0．018），其预测急诊PCI术后冠脉造影无复流的敏感度为60．0％，特异度为87．5％。结论入院时NT—proBNP水平作为一项生物学标志物可能具有预测和协助诊断急诊PCI术后冠脉造影无复流发生的价值。

Objective To determine the relationship between N-terminal pro-brain-type natriuretic peptide （NT-proBNP） and angiographic no-reflow phenomenon in patients with acute myocardial infarction （AMI） after primary percutaneous coronary intervention （PCI）. Methods The data of 106 consecutive AMI patients undergoing primary PCI were collected and analyzed retrospectively. NT-proBNP was obtained pre-PCI at admission. According to the NT-proBNP level, they were divided into normal and elevated NT-proBNP groups. The no-reflow phenomenon was defined as an angiographie outcome of Thrombolysis In Myocardial Infarction （TIMI） grade 〈 3 without accompanying mechanical factors. Results The patients with elevated NT-proBNP on admission had a higher incidence of no-reflow phenomenon than those with NT-proBNP level. Compared to normal reflow counterparts, no-reflow patients had a higher NT-proBNP level [ 1883 ng/L （484 - 5500 ng/L） vs 220 ng/L （ 87 - 926 ng/L） P = 0. 046 ]. Multivariate analysis showed that a high NT-proBNP level （NT-proBNP 〉 1765 ng/L ） on admission was an independent predictor of no-reflow. This cut-off value yielded a sensitivity of 60. 0% and a specificity of 87. 5% respectively. Conclusion The NT-proBNP level on admission may be a prognostic biomarker in the prediction of the development of angiographic ＂no-reflow＂ phenomenon after primary PCI for AMI patients.