红细胞分布宽度联合NT-proBNP预测ST段抬高型心肌梗死急诊PCI后心电图ST段回落不良的临床价值

Clinical value of RBC with NT-proBNP in predicting poor ST-segment resolution after PCI in patients with ST-segment elevation myocardial infarction

目的探讨红细胞分布宽度(RDW)联合N末端脑钠肽前体(NT-proBNP)预测ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)后心电图ST段回落不良的临床价值。方法2017年1月至2019年1月252例接受急诊PCI治疗的STEMI患者,按照PCI后60min时的心电图ST段回落情况分为ST段回落不良组和ST段回落良好组,比较两组临床资料、RDW和NT-proBNP。结果ST段回落不良组Killip分级≥2级、前壁心肌梗死比例、胸痛到球囊扩张时间、入院时肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、血尿酸(UA)、纤维蛋白原、甘油三酯(TG)高于ST段回落良好组,差异均有统计学意义(均P<0.01)。ST段回落不良组NT-proBNP[(4310.34±1514.65)pg/ml]显著高于ST段回落良好组[(2714.71±854.56)pg/ml](t=12.545,P<0.01)。ST段回落不良组RDW[(15.94±1.24)%]显著高于ST段回落良好组[(14.67±1.18)%](t=4.331,P<0.01)。多元logistic回归方程显示NT-proBNP、RDW是STEMI患者PCI后ST段回落不良的独立危险因素(均P<0.01)。NT-proBNP和RDW预测PCI后ST段回落的ROC曲线下面积分别为0.771和0.689,联合NT-proBNP和RDW预测的ROC曲线下面积为0.849(0.738~0.920),显著高于两者单独预测的面积(Z=2.910,P<0.05)。结论RDW联合NT-proBNP有助于预测STEMI患者PCI后ST段回落不良。

Objective To explore the clinical value of red blood cell distribution width(RDW)with N-terminal brain natriuretic peptide precursor(NT-proBNP)in predicting ST-segment resolution in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods 252 STEMI patients treated with PCI from January 2017 to January 2019 were enrolled and divided into group with or without ST-segment resolution at 60 minutes after PCI.Clinical data,RDW and NT proBNP were compared between the two groups.Results Killip grade≥2,anterior myocardial infarction ratio,time from chest pain-onset to balloon dilation,CK-MB,hs-CRP,UA,fibrinogen and TG were significantly higher in group without ST-segment resolution than in group with ST-segment resolution(all P<0.05).NT-proBNP and RDW were significantly higher in group without than with ST-segment resolution[(4310.34±1514.65)pg/ml,(15.94±1.24)%vs.(2714.71±854.56)pg/ml,(14.67±1.18)%,respectively,all P<0.01].Multivariate logistic regression showed that NT-proBNP and RDW were independent risk factors for poor ST-segment regression in STEMI patients after PCI(all P<0.01).The area under ROC curve was 0.771 for NT proBNP and 0.689 for RDW in predicting ST-segment resolution.The area under ROC curve for NT-proBNP combined with RDW was 0.849(0.738~0.920),which was significantly higher than each of them(Z=2.910,P<0.05).Conclusion RDW combined with NT-proBNP may be used to predict poor ST-segment resolution in STEMI patients after PCI.