血浆标志物对急性心肌梗死患者住院期间并发谵妄的预测价值分析

Plasma biomarkers for predicting occurrence of delirium in patients with acute myocardial infarction during hospitalization

目的分析和比较血浆肌钙蛋白Ⅰ(cTnⅠ)、精氨酸-加压素(AVP)、和肽素(COP)、心钠肽(ANP)、脑钠肽(BNP)、氨基末端脑钠肽原(NT-proBNP)和肾上腺髓质素(ADM)浓度对急性心肌梗死(AMI)患者住院期间并发谵妄的预测价值。方法收集AMI患者320例和健康体检者(对照组)160例,采用酶联免疫吸附法检测血浆cTnⅠ、AVP、COP、ANP、BNP、NT-proBNP和ADM浓度,采用ROC曲线分析和比较标志物对AMI患者住院期间并发谵妄的预测价值。结果 AMI患者血浆血浆cTnⅠ、AVP、COP、ANP、BNP、NT-proBNP和ADM浓度均高于对照组(均P<0.01)。50例(15.6%)患者住院期间并发谵妄。并发谵妄患者血浆标记物浓度均高于非并发谵妄患者(均P<0.01)。这些血浆标记物均显著预测谵妄的发生(均P<0.01),COP及NT-proBNP的预测能力显著超过cTnⅠ(均P<0.05),其他指标的预测能力与cTnⅠ比较均无统计学差异(均P>0.05)。联合检测血浆COP及NT-proBNP可以显著提高它们单个检测的预测价值(均P<0.05)。结论血浆COP及NT-proBNP对AMI患者住院期间并发谵妄具有较高的预测价值,两者联合检测预测能力更高。

Objective To assess the predictive value of plasma cardiac troponinⅠ（cTn I）,copeptin,arginine vasopressin（AVP）,atrial natriuretic peptide（ANP）,N-terminal fragment of pro-brain natriuretic peptide（NT-proBNP）,brain natriuretic peptide（BNP） and adrenomedullin（ADM） levels for occurrence of delirium secondary to acute myocardial infarction during hospital stay.Methods Three hundred and twenty patients with acute myocardial infarction and 160 healthy subjects（controls） were enrolled in the study.Enzyme-linked immune sorbent assay was used to determine plasma concentrations of biomarkers.The value of biomarkers in predicting occurrence of in-hospital delirium was analyzed with receiver operating characteristic（ROC） curve.Results Plasma concentrations of these biomarkers were significantly higher in the acute myocardial infarction patients than those in the controls（all P〈0.01）.In-hospital delirium developed in 50 patients（15.6%）.Patients with delirium had significantly higher plasma concentrations of these biomarkers than those without delirium（all P〈0.01）.The predictive ability of copeptin and NT-proBNP was significantly higher than that of cTnⅠ（both P〈0.05）;while there were no significant differences in predictive ability between cTn I and other biomarkers（all P〈0.05）.Combination of copeptin with NT pro-BNP significantly increased the predictive performance compared to two biomarkers alone（both P〈0.05）.Conclusion Plasma concentrations of copeptin and NT-proBNP possess high predictive value for occurrence of in-hospital delirium in patients with acute myocardial infarction,and combined detection of these two biomarkers may further increase the predictive performance.