血清生物标记物对急性心肌梗死患者院内心功能衰竭的预测价值

Prediction value of serum biomarkers in hospital heart failure for the patients with acute myocardial infarction

目的综合分析与判断急性心肌梗死(acute myocardial infarction,AMI)患者临床常用的血清标记物与患者院内发生心功能衰竭(hospital heart failure,HHF)的预测关系。方法纳入河南省人民医院心内科2014年3月至2016年8月收治的294例AMI患者并检测患者血清中肌酸激酶同工酶MB(creatine kinase isoenzyme MB,CK-MB)、天门冬氨酸转氨酶(aspartate aminotransferase,AST)、心肌激酶(cardiac kinase,CK)、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌红蛋白(myoglobin,MYO)、心肌肌钙蛋白(cardiac troponin,cTn)T、cTnI、脑钠肽(brain natriuretic peptide,BNP)、高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)、胆固醇(totalcholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)浓度。根据HHF发生与否将所有患者分为发生HHF组和未发生HHF组。采用多因素Logistic回归模型分析发生HHF的预测风险因素,采用受试者工作特性(receiver operatingcharacteristic,ROC)曲线分析HHF发生风险因素的诊断效能。结果影响HHF发生的最强的独立风险因素是hs-CRP(OR=9.545,95%CI:2.2~41.418),其次是cTnI、cTnT、HDL-C和BNP,其OR值和95%CI分别为(OR=4.685,95%CI:1.206~18.199),(OR=3.487,95%CI:1.874~6.489),(OR=3.536,95%CI:0.555~22.519)和(OR=2.018,95%CI:1.266~3.216)。BNP和cTnT对HHF发生诊断效能的ROC曲线下面积分别是0.833(95%CI:0.787~0.879)和0.824(95%CI:0.778~0.869),BNP在截点值为317.95 pg/m L时,诊断的敏感性和特异性分别为89.7%和75.5%,而cTnT在截点值为11.62μg/L时,诊断的敏感性和特异性分别为88.4%和82.7%。结论临床常用的血清标志物中,BNP、cTnT、HDL-C、cTnI和hs-CRP在AMI患者HHF发生中有着较大的预测价值,且联合检测可以提高心力衰竭的诊断效能。

Objectives To perform comprehensive analysis and estimation for the prediction value of serum biomarkers in hospital heart failure （HHF） in the patients with acute myocardial infarction （AMI）. Methods Clinical data of 294 cases with AMI from March 2014 to August 2016 in The People′s Hospital of Henan Province were collected. The patients were divided into two groups according to the occurrence of HHF. Serum concentrations of creatine kinase isoenzyme MB（CK-MB）,aspartate aminotransferas（AST）,cardiac kinase（CK）,lactate dehydrogenase（LDH）, （myoglobin（MYO）,cardiac troponin（cTn）T,cTnI,brain natriuretic peptide（BNP）,high sensitivity C-reactive protein （hs-CRP）,total cholesterol （TC）,low-density lipoprotein cholesterol （LDL-C）,high-density lipoprotein cholesterol（HDL-C）were detected. Risk factor of HHF occurrence was assessed using Logistic regression model ,and diagnostic efficiency of the factors for HHF occurrence were tested by receiver operating characteristic （ROC）curve. Results The robust independent risk factor for HHF occurrence were hs-CRP（OR=9.545,95%CI：2.2-41.418）, which followed by cTnI,cTnT,HDL-C,and BNP,their OR and 95%CI were（OR=4.685,95%CI：1.206-18.199）, （OR=3.487,95%CI：1.874-6.489）,（OR=3.536,95%CI：0.555-22.519）and（OR=2.018,95%CI：1.266-3.216）, respectively. Areas under ROC curve（AUC）of BNP and cTnT for HHF diagnosis were 0.833（95%CI：0.787-0.879） and 0.824（95%CI：0.778-0.869）,respectively. The sensitivity and specificity of BNP for diagnosis of HHF were respectively 89.7% and 75.5% when its cut-off value was 317.95 pg/mL,while that of cTnT was respectively 88.4%and 82.7%when its cut-off value was 11.62μg/L. Conclusions In clinical common serum biomarkers,BNP,cTnT, HDL-C,cTnI and hs-CRP have higher predictive value for HHF occurrence in patients with AMI,moreover,the diag-nostic efficiency of heart failure can be improved by combined detection.