红细胞分布宽度和脑钠肽水平与急性心肌梗死患者并发心房颤动的相关性

Relationship between red blood cell distribution width and brain natriuretic peptide level and atrial fibrillation in patients with acute myocardial infarction

目的探讨红细胞分布宽度(RDW)、脑钠肽(BNP)水平与急性心肌梗死后并发心房颤动的相关性。方法选择2016年3月至2018年3月新乡市中心医院收治的急性心肌梗死并发心房颤动患者30例为观察组,另选择同期未并发心房颤动的急性心肌梗死患者30例为对照组。采集2组患者空腹静脉血,分离血清,采用电化学发光免疫法检测血清N末端脑钠肽前体(NT-proBNP)及心肌肌钙蛋白I(cTnI)水平,采用免疫比浊法检测RDW、BNP、血红蛋白(Hb)及平均红细胞体积(MCV),采用生物化学分析仪检测低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)、总胆固醇(TC)、三酰甘油(TG)、血糖、血尿素氮(BUN)、血肌酐及血清铁(Fe)水平,采用超敏乳胶增强散射比浊法检测超敏C反应蛋白(hs-CRP)水平。采用logistic多元回归模型分析急性心肌梗死患者并发心房颤动的影响因素,采用Spearman秩相关分析RDW、BNP水平与NT-proBNP、cTnI和hs-CRP的相关性。结果2组患者的年龄、性别、吸烟史、高血压史、糖尿病史、住院时间、收缩压、舒张压及体质量指数比较差异均无统计学意义(P>0.05)。观察组患者RDW、BNP、血肌酐、NT-proBNP、hs-CRP及cTnI水平均显著高于对照组(P<0.05),2组患者Hb、MCV、LDLC、HDLC、TC、TG、血糖、BUN及血清Fe水平比较差异均无统计学意义(P>0.05)。2组患者左心房内径比较差异无统计学意义(P>0.05);观察组患者左心室舒张末期内径显著高于对照组,左心室射血分数显著低于对照组(P<0.05)。NT-proBNP、cTnI、hs-CRP、RDW和BNP是急性心肌梗死患者并发心房颤动的影响因素(P<0.05)。RDW与NT-proBNP、cTnI、hs-CRP呈正相关(r=0.308、0.291、0.211,P<0.05),BNP水平与NT-proBNP、cTnI、hs-CRP呈正相关(r=0.412、0.253、0.204,P<0.05)。结论RDW、BNP水平与急性心肌梗死后并发心房颤动相关,可作为急性心肌梗死后并发心房颤动的预测指标。

Objective To study the relationship between red blood cell distribution width(RDW),brain natriuretic peptide(BNP) level and atrial fibrillation after acute myocardial infarction. Methods Thirty patients with atrial fibrillation after acute myocardial infarction in Xinxiang Central Hospital from March 2016 to March 2018 were selected as observation group;and another 30 patients with acute myocardial infarction during the same time period were selected as control group.The fasting venous blood of patients in the two groups was collected and the serum was separated.The levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTn I) were determined by electrochemiluminescence immunoassay;the levels of RDW,BNP,hemoglobin (Hb) and mean corpuscular volume (MCV) were detected by immunoturbidimetry;the levels of low-density lipoprotein cholesterol (LDLC),high-density lipoprotein cholesterol (HDLC),total cholesterol (TC),triacylglycerol (TG),blood glucose,blood urea nitrogen (BUN),serum creatinine and serum iron (Fe) were detected by biochemical analyzer;the hypersensitive C-reactive protein (hs-CRP) level was detected by latex-enhanced immunonephelometry method.Logistic multivariate regression model was used to analyze the influencing factors of atrial fibrillation after acute myocardial infarction.Spearman rank correlation analysis was used to compare the correlation between RDW,BNP level and NT-proBNP,cTn I,hs-CRP. Results There was no significant difference in the age,gender,smoking history,history of hypertension,history of diabetes,hospital stay,systolic blood pressure,diastolic blood pressure and body mass index between the two groups ( P >0.05).The levels of RDW,BNP,serum creatinine,NT-proBNP,hs-CRP and cTn I of patients in the observation group were significantly higher than those in the control group ( P <0.05).There was no significant difference in the level of Hb,MCV,LDLC,HDLC,TC,TG,blood glucose,BUN and serum Fe between the two groups ( P >0.05).There was no significant difference in the left atrial diameter between the two groups ( P >0.05);the left rentricular end-diastolic diameter of patients in the observation group was significantly higher than that in the control group( P <0.05);while the left ventricular ejection fraction was significantly lower than that in the control group ( P <0.05).The NT-proBNP,cTn I,hs-CRP,RDW and BNP were the influencing factors of atrial fibrillation after myocardial infarction ( P <0.05).RDW was positively correlated with the NT-proBNP,cTn I and hs-CRP ( r =0.308,0.291,0.211;P <0.05).The BNP level was positively correlated with the NT-proBNP,cTn I and hs-CRP ( r =0.412,0.253,0.204;P <0.05). Conclusion RDW and BNP level are associated with atrial fibrillation after acute myocardial infarction,which can be used as prediction indexes to the diagnosis and treatment of atrial fibrillation after acute myocardial infarction.