神经元特异性烯醇化酶对急性ST段抬高型心肌梗死患者发生心力衰竭的预测价值

Predictive value of neuron specific enolase level for in-hospital heart failure in patients with acute ST-segment elevation myocardial infarction

目的：评价神经元特异性烯醇化酶（NSE）对急性ST段抬高型心肌梗死（STEMI）患者住院期间发生心力衰竭（心衰）的预测价值。方法：连续收集2011年1月至2012年12月住院的STEMI患者508例。收集患者临床资料，检测血清NSE及氨基末端B型脑钠肽前体（NT—pro—BNP）浓度、血肌酐（Cr）、肝功能和心肌酶。观察患者住院期间发生心衰的情况。依据心衰KilliD分级分为心衰组和非心衰组，比较2组临床特征及NSE、NT—pro—BNP浓度的差异。采用Spearman秩相关分析NSE与各临床因素间的关系：应用多因素Logistic回归分析影响住院期间STEMI患者发生心衰的相关因素：采用受试者工作特征（ROC）曲线评价NSE和NT—pro—BNP对住院期间STEMI患者发生心衰的预测价值。结果：与非心衰组相比，心衰组患者NSE、NT—pro-BNP浓度高。随着患者心功能的恶化，NSE、NT—pro—BNP浓度逐渐升高（P〈0．001）。Spearman秩相关分析显示NSE与天冬氨酸转氨酶（AST）、肌酸激酶（CK）呈明显正相关（AST：r=0．342．P〈0．001：CK：r=0．377，P〈0．001），与左心室射血分数（LVEF）呈显著负相关（r=-0．342，P〈0．001）。多因素Logistic回归分析显示NSE是住院期间STEMI患者发生心衰的独立危险因素『风险比（HR）=1．021，95％可信区间（CI）：1．003～1．040，P=0．023]，其预测住院期间心衰发生的ROC曲线下面积（AUC）为0．674（P〈0．001）。结论：NSE是STEMI患者住院期间心衰发生的独立危险因素．对预测STEMI患者住院期间心衰的发生有一定价值。

Objective To determine whether neuron specific enolase （NSE） level could predict the risk of developing in-hospital heart failure in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Five hundred and eight STEMI patients at Shanghai 6th People＇s Hospital from Jan 2011 to Dec 2012 were enrolled in this study. Clinical data including serum NSE and N-terminal pro-B-type natriuretic peptide （NT-pro-BNP） level, blood ereatinine, and myocardial enzymes were collected. The patients were categorized into heart failure and non-heart failure groups according to Killip classification. The clinical characteristics and value of NSE and NT-pro-BNP were compared between the two groups. The correlation between NSE and each of the clinical factors was analyzed by Spearman rank correlation, multivariate Logistic regression analysis was applied to determine the correlation between risk factors and in-hospital heart failure. Receiver-operator characteristic （ROC） curve was performed to evaluate the value of NSE and NT-pro-BNP for predicting in-hospital heart failure. Results NSE and NT-pro-BNP levels in heart failure group were higher than that in non heart failure group. With the deterioration of heart function, the level of NSE, NT-pro-BNP increased gradually （P〈 0.001）. Spearman rank correlation analysis showed that NSE was positively correlated with aspartate aminotransferase （AST） and creatine kinase （CK） （AST：r=0.342,P〈0.001;CK.r=0.377,P〈0.001） and negatively correlated with left ventricular ejection fraction （LVEF） （r=-0.342, P〈0.001）. After adjustment for multiple variants, NSE remained to be an independent risk factor for developing in-hospital heart failure [hazard ratio （HR）=I.021,95% confidence interval （CI）：1.003-1.040,P=0.023]. The area under ROC curve of NSE was 0.674 （P〈0.001）. Conclusions The NSE level is an independent predictor for the development of in-hospital heart failure in patients with STEMI, and is valuable for predicting the occurrence of heart failure in STEMI patients.