急诊经皮冠状动脉介入治疗前后脑钠肽水平与左室室壁运动积分指数的关系

Relationship between BNP levels of patients with acute ST-segment elevation myocardial infarction before and after treatment of emergency PCI and LVWMSI

目的研究急性ST段抬高型心肌梗死(STEMI)病人急诊行经皮冠状动脉介入治疗(PCI)治疗前后脑钠肽(BNP)水平与左室室壁运动积分指数(LVWMSI)之间的相关性。方法选择急诊行PCI治疗STEMI病人的临床病历资料102例,根据急诊PCI术后梗死相关动脉(IRA)再通情况再分为再通组(45例)和非再通组(57例),分别于病人入院时、PCI术后24 h、入院后1周测定其外周血BNP和肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)等心肌损伤指标,同时测定病人三个时间点的左心室射血分数(LVEF)和LVWMSI。采用重复测量资料的方差分析和独立样本t检验,分析上述指标在各组内和组间不同时间点的特点及变化规律;采用Pearson相关分析,分析不同时间点BNP水平与相应时间上述指标的相关性,并采用偏相关分析,控制影响因素,分析BNP与LVWMSI相关性;采用Cox比例风险回归模型分析急诊PCI术后再发心血管不良事件的相关影响因素。结果入院时再通组病人BNP和LVWMSI明显低于对照组,LVEF明显高于对照组,均差异有统计学意义(P<0.05),而两组间CK、CK-MB、c Tn I等心肌损伤指标在术前均差异无统计学意义(P>0.05)。PCI术后24 h及入院后1周再通组BNP[(5.014±1.843)ng·L^(-1)、(4.621±1.137)ng·L^(-1)]、CK[(1 912.35±468.32)U·L^(-1)、(1 764.27±376.07)U·L^(-1)]、CK-MB[(206.21±30.65)U·L^(-1)、(191.23±24.09)U·L^(-1)]、c Tn I[(2.74±3.07)ng·L^(-1)、(10.18±2.86)ng·L^(-1)]和LVWMSI[(57.52±7.27)、(52.72±5.6)]均明显低于非再通组BNP[(5.732±1.207)ng·L^(-1)、(5.462±1.329)ng·L^(-1)],CK[(2 132.06±503.42)U·L^(-1)、(1 924.37±426.68)U·L^(-1)],CK-MB[(228.09±24.31)U·L^(-1)、(213.45±23.17)U·L^(-1)]、c Tn I[(14.25±2.89)ng·L^(-1)、(12.64±3.47)ng·L^(-1)],LVWMSI[(63.49±6.87)、(56.17±6.14)];LVEF明显高于非再通组[(51.36±7.58)、(57.69±5.07)]/[(45.39±8.94)、(46.08±6.87)],均差异有统计学意义(P<0.05)。BNP、LVEF、LVWMSI及CK、CK-MB、c Tn I等指标,组内不同时间点均差异有统计学意义(P<0.05),其中BNP[(5.014±1.843)ng·L^(-1)、(5.732±1.207)ng·L^(-1)]和LVWMSI[(57.52±7.27)、(63.49±6.87)]在术后24 h水平最高。不同时间点BNP水平与CK、CK-MB、c Tn I、LVWMSI均呈正相关,与LVEF呈负相关;偏相关分析显示,控制其他影响因素外,BNP水平LVWMSI依然呈正相关(r=0.413,P<0.05)。Cox比例风险回归模型结果显示:BNP(HR=1.550,P<0.05)和LVWMSI(HR=1.648,P<0.05)均与心血管不良事件再发生的风险显著相关。结论 STEMI病人急诊行PCI治疗前后脑钠肽BNP水平与LVWMSI水平始终呈正相关,而且PCI治疗前两者已早于心肌损伤指标表现出明显差异,同时两者均与病人术后再次发生心血管不良事件独立相关。

Objective To investigate the relationship between BNP(B-type natriuretic peptide) levels of patients with acute ST-segment elevation myocardial infarction before and after treatment of emergency PCI and LVWMSI(left ventricular wall motion score index).Methods Clinical data of 102 patients visiting Emergency Department of Hefei Second People's Hospital from June 2014 to June 2015 were chosed and assigned into two groups,recanalization group(45 cases) and non-reperfusion group(57 cases),according to the infarct-related artery after PCI emergency. BNP,CK(creatine kinase),CK-MB(creatine kinase isoenzyme-MB),c Tn I(cardiac troponin I),LVEF and LVWMSI of all patients were respectively measured on admission,24 h and one week after PCI. Analysis of variance of repeated measurement data and independent samplet test were used to analyze the characteristics and the laws of these indicators at different time within or between groups. Pearson correlation between BNP levels and these indicators at different time were analyzed and Partial correlation analysis was used to control the impact of other variables and analyze the correlation between BNP and LVWMSI.Factors related with recurrent cardiovascular adverse events after emergency PCI were analyzed using Cox proportional hazards regression model. Results BNP and LVWMSI in recanalization group on admission were all significantly lower than non-reperfusion group,while LVEF was significantly higher than non-reperfusion group,the difference was statistically significant(P < 0. 05),and CK,CKMB,c Tn I had no statistically significant difference between the two groups(P > 0. 05). BNP(5. 014 ± 1. 843 ng·L^(-1),4. 621 ± 1. 137ng·L^(-1)),CK(1912. 35 ± 468. 32 U·L^(-1),1764. 27 ± 376. 07 U·L^(-1)),CK-MB(206. 21 ± 30. 65 U·L^(-1),191. 23 ± 24. 09 U·L^(-1)),c Tn I(2. 74 ± 3. 07 ng·L^(-1),10. 18 ± 2. 86 ng·L^(-1)) and LVWMSI(57. 52 ± 7. 27,52. 72 ± 5. 6) of recanalization group in 24 h and one week after PCI were significantly lower than BNP(5. 732 ± 1. 207 ng·L^(-1),5. 462 ± 1. 329 ng·L^(-1)),CK(2132. 06 ± 503. 42U·L^(-1),1924. 37 ± 426. 68 U·L^(-1)),CK-MB(228. 09 ± 24. 31 U·L^(-1),213. 45 ± 23. 17 U·L^(-1)),c Tn I(14. 25 ± 2. 89 ng·L^(-1),12. 64 ± 3. 47 ng·L^(-1)) and LVWMSI(63. 49 ± 6. 87,56. 17 ± 6. 14) of non-reperfusion group,while LVEF(51. 36 ± 7. 58,57. 69 ±5. 07/45. 39 ± 8. 94,46. 08 ± 6. 87) was significantly higher than that of non-reperfusion group; the differences were statistically significant(P < 0. 05). Differences in BNP,LVEF,LVWMSI and CK,CK-MB,c Tn I at different time within groups were statistically significant(P < 0. 05),in which the BNP(5. 014 ± 1. 843 ng·L^(-1)/5. 732 ± 1. 207 ng·L^(-1)) and LVWMSI(57. 52 ± 7. 27/63. 49 ± 6. 87)were at the highest level after 24 hours. BNP was positively correlated with CK,CK-MB,c Tn I,and LVWMSI at different time and negatively correlated with LVEF. Partical correlation analysis showed that BNP remained positively correlated with LVWMSI when other influence factors were controlled(r = 0. 413,P < 0. 05). Cox proportional hazards regression model showed that: BNP(HR = 1. 550,P <0. 05) and LVWMSI(HR = 1. 648,P < 0. 05) were independently and significantly associated with recurrence risk of cardiovascular events. Conclusions BNP was always positively correlated with LVWMSI for STEMI patients before and after PCI emergency. They both showed a significant difference earlier than myocardial injury indicators before PCI,meanwhile both were independently associated with the recurrence of cardiovascular events.