N端B型利钠肽原对ST段抬高型心肌梗死患者病情及预后评估的价值

The value of N-terminal pro-B-type natriuretic peptide for evaluating the disease condition and prognosis in patients with ST-segment elevation myocardial infarction

目的探讨N端B型利钠肽原（NT-proBNP）对急性ST段抬高型心肌梗死（STEMI）患者病情及预后评估的价值。方法选取STEMI患者240例,平均年龄57.28±15.67岁。每例患者均行急诊经皮冠状动脉介入术。记录每例患者吸烟史、饮酒史、高血压病史、糖尿病病史。测定血浆NT-proBNP浓度;检测血液生化指标及心肌肌钙蛋白I（cTnⅠ）、高敏C反应蛋白（hs-CRP）和血常规。行心脏彩色超声检查。随访出院后6个月内发生的主要不良心血管事件（MACE）,包括心源性死亡、非致死性心肌梗死和靶血管血运重建。结果 STEMI患者血浆NTproBNP水平与年龄、左心室舒张末期内径呈正相关（r分别为0.39、0.23,均P〈0.001）,与左心室射血分数呈负相关（r为-0.34,P〈0.001）。血浆NT-proBNP浓度随心功能Killip分级增加而升高（P〈0.001）,随Gensini积分增加而升高（P〈0.001）。前壁心肌梗死病人血浆NT-proBNP浓度最高（P〈0.001）。多因素Logistic回归分析显示年龄、Lg[NT-proBNP]、cTnⅠ、hs-CRP均与MACE相关,Lg[NT-proBNP]为MACE的最强预测因子（P〈0.001）。ROC曲线分析显示NT-proBNP对MACE预测的最佳截断值为4069.5 ng/L。结论血浆NT-proBNP水平与STEMI患者病情的严重程度相关,是STEMI患者发生MACE的最强预测因子。

Aim To investigate the value of N-terminal pro-B-type natriuretic peptide（ NT-proBNP） for evaluating the disease condition and prognosis in patients with acute ST-segment elevation myocardial infarction（ STEMI）.Methods 240 cases of STEMI patients were selected,the average age was 57.28±15.67 years old. Each patient underwent emergency percutaneous coronary intervention. The history of smoking,drinking,hypertension,and diabetes were recorded in each case. Plasma NT-proBNP concentration was measured. Blood biochemical indexes and cardiac troponin I（ cTnⅠ）,high-sensitivity C-reactive protein（ hs-CRP） and blood routine were detected. Color Doppler echocardiography was used to examine the heart. The main adverse cardiovascular events（ MACE） occurred within 6 months after discharge were followed up,including cardiac death,nonfatal myocardial infarction,and revascularization of the target vessel blood.Results The plasma NT-proBNP level in patients with STEMI was positively correlated with age and left ventricular enddiastolic diameter（ r value was 0.39,0.23,respectively,all P〈0.001）,and was negatively correlated with left ventricular ejection fraction（ r value was-0.34,P〈0.001）. Plasma NT-proBNP concentration increased with the increase of cardiac function Killip grade（ P〈0.001）,and increased with the increase of Gensini score（ P〈0.001）. Plasma NT-proBNP concentration was the highest in patients with anterior wall myocardial infarction（ P〈0.001）. Multiple factor Logistic regression analysis showed that age,Lg[NT-proBNP],cTnⅠ and hs-CRP were all associated with MACE,and Lg[NT-proBNP]was the strongest predictor of MACE（ P〈0.001）. ROC curve analysis showed that the best cut-off value of NT-proBNP predicting MACE was 4069.5 ng/L. Conclusion The level of plasma NT-proBNP is associated with the severity of the STEMI patient＇s condition,and NT-proBNP is the strongest predictor of MACE in STEMI patients.