双峰型NT-proBNP在急性ST抬高型心肌梗死病人近期预后评估中临床价值研究

THE CLINICAL VALUE OF DOUBLE-PEAKS TYPE NT-PROBNP IN THE SHORT-TERM PROGNOSIS EVALUATION OF PATIENTS WITH ACUTE ST EVALUATION MYOCARDIAL INFARCTION

目的:通过动态监测急性ST抬高型心肌梗死(STEMI)病人NT-proBNP血浆水平,制作时间-浓度水平曲线,分析影响双峰型NT-proBNP形成的临床指标,探讨双峰型NT-proBNP对STEMI病人预后判断中的临床价值。方法:入选西安市北方医院2015-08~2017-08收治的STEMI病人200例。记录心梗后6 h、12 h、14h、16 h、18 h、24 h、2 d、3 d、4 d、5 d、6 d、7 d的NT-proBNP血浆水平;以年龄、性别、是否有高血压史、是否糖尿病史、是否为前壁心肌梗死、梗死后48 h内EF值是否大于45%、Killip分级、QRS时程是否大于120 ms、心肌酶峰是否大于400 IU/L、e GFR是否大于60m L/min、是否存在重症感染、是否尿酮体阳性为自变量,以是否双峰型NT-proBNP为应变量,采用Logistic回归分析,建立拟合模型,分析影响形成双峰型NT-proBNP主要临床变量。以心梗后28 d心脏不良事件为临床观察终点,探讨单峰型及双峰型NT-proBNP预后判断价值。结果:(1)单峰型STEMI病人心肌梗死后中位数时间17.6h出现NT-proBNP第1个峰值,峰值均值约4790±1160 pg/m L;双峰型NT-proBNP病人,在中位数时间为4.3d时出现第2个峰值。(2)通过Logistic回归分析,建立多自变量拟合模型,3个临床指标:前壁心肌梗死、心肌酶峰值CKMB大于400 U/L、e GFR小于60m L/min是形成峰型NTproBNP影响因子。(3)双峰型NT-proBNP与心梗后28 d主要心脏不良事件关系密切。结论:(1)对于前壁心肌梗死、心肌酶峰值高及肾功不全的STEMI病人,应动态监测心梗后NT-proBNP血浆水平;(2)双峰型NTproBNP是急性STEMI病人短期预后不良独立危险因素。

Objective：Dynamic monitoring of serum NT-proBNP levels in patients with acute ST elevation myocardial infarction, making time-serum curve, analyzing the clinical indicators affecting theformation of double-peaks type NT-proBNP, investigating the clinical value of double-peaks type NT- proBNP in the prognosis of patients with STEMI.lMetliods：From August 2015 to August 2017,200 pa-tients with acute ST segment elevation myocardial infarction were selected from X iran North hospital.Serum levels of 12 h、14 h、16 h、18 h、24h ,2 d ,3 d,4 d ,5 d,6 d and 7 d NT-proBNP after myocardial infarction were recorded, and time - serum curve was made. We introduce 12 variables ： age, gender, whether there is a history of hypertension, diabetes history,whether EF value is greater than 45%,Ki l l ip grades,whether QRS duration is greater than 120 ms,the peak myocardial enzymes〉400 the existence of severe infection,whether the urine ketone body positive ,andthe doubl-proBNP is the strain. ^Logistic regression analysis was used to establish the fitting model and analyzethe main clinical variables affecting the formation of double-peaks type NT-proBNP.＂Taking the 28 day MACE after myocardial infarction as the endpoint of clinical observation, we evaluated the prognostic value of double-peaks type NT- proBNP. Results ： （ 1 ） The median 17.6h after myocardial infarction showed the first peak of NT-proBNP, with a peak value of about 4790 ＋ 1160 pg/mL.In double-peaks type NT-proBNP patients,second peaks occurred at the median time of 4.3d.（2） 3 clinical indicators： anterior wall myocardial infarction, myocardial enzyme peak CKMB greater than 400 U^L,eGFR less than 60mlVmin,is the impact of double-peaks type NT-proBNP formation of clinical indicators. （ 3 ） Double-peak type NT-proBNP is closely related to the 28 day MACE after myocardial infarction.（ Con-clusion; （1）The serum levels of NT-proBNP should be monitored dynamically in with anterior wall myocardial infarction,high peak myocardial enzymes and renal insufficiency. （ 2）Double-peaks type NT-proBNP is an independent risk factor for short-term prognoacute STEMI.