急性心肌梗死后血浆脑钠肽水平与心室重构的关系研究

Correlation between plasma brain natriuretic peptide and left ventricular remodeling

目的探讨急性心肌梗死(AMI)后血浆脑钠肽(BNP)水平对心梗后心室重构的预测价值及判断作用。方法纳入120例首发AMI患者,根据心脏多普勒超声的检测情况分为心室重构组和心室非重构组。在发病后72 h内及90 d时,检测血浆BNP和ANP含量。出院后90 d时随访。半年后进行超声检测,综合评价心室重构情况。结果纳入120例,成功随访101例。依据△LVEDVI值分为重构组39例,非重构组62例。重构组发病后72 h内及90 d时的血浆BNP、ANP水平均显著高于非重构组。BNP2水平与△LVEDVI相关系数最大。多元线性回归分析显示,心梗发病90 d时的血浆BNP水平与心室重构的关系最为密切,可作为独立预测指标。ROC曲线分析表明BNP对心室重构的判断价值大于ANP,其中BNP2价值最大。血浆BNP2≥410 pg/mL,判断心室重构的敏感度为0.80,特异度为0.70。结论心梗后90 d的血浆BNP水平可作为心室重构的独立相关指标,这对预测AMI患者发生心室重构提供了一种新的无创且有效的实验室指标。

Objective To study the predictive and diagnostic value of plasma BNP levels after acute myocardial infarction （AMI） in patients with left ventricular remodeling. Methods A total of 120 patients with first - time onset of AMI were included in the study. According to Car- diac Doppler ultrasound data, patients were divided into groups of ventricular remodeling group and non - ventricular group. Plasma BNP and ANP levels were detected within 72 hrs and 90 days af- ter onset of the disease. Follow- up was conducted 90d after discharge. Six months later, ultra- sound examination was conducted again to comprehensively assess ventricular remodeling. Results A total of 120 patients were included in the study and 101 cases were successfully followed up. Based on ALVEDVI scores, the 101 cases were further divided into remodeling group （n = 39） and non - remodeling group （ n = 62）. The levels of plasma BNP2 and ANP of the remodeling group within 72h and 90d were significantly higher than those of the non - modeling group. BNP2 level was highly relevant to/x LVEDVI. Multiple linear regre^ion analysis showed that myocardial infarction plasma BNP level at 90 d was highly relevant to ventricular remodeling and it could be used as an independent predictor. ROC curve analysis showed that the diagnostic value of BNP on ventricular remodeling was greater than that of ANP. BNP2 was the indicator with the greatest predictive value. When plasma BNP2 acuity was 410 pg/mL, the sensitivity of ventricular remod- eling was 0.80, and the specificity was 0.70. Conclusion Plasma BNP level at 90d can be regard- ed as an independent index for ventricular remodeling, which is a noninvasive and effective laboratory index to predict ventricular remodeling for AMI patients.