血浆脑利钠肽水平对急性ST段抬高型心肌梗死急诊介入治疗后近期心室重构的预测价值

The predictive value of plasma BNP for recent ventricular remodeling in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者急诊冠状动脉介入(primary percutaneous coronary intervention,p-PCI)治疗后血浆脑利钠肽(brain natriuretic peptide,BNP)水平对术后6个月内左心室重构的预测价值。方法连续收集AMI患者100例作为研究对象,所有患者均于发病12 h内完成p-PCI治疗,于发病24 h时采肘静脉血检测血浆BNP水平。分别于术后第7天和术后6个月进行超声心动图检查,测定左心室舒张末期容积值(left ventricular end diastolic volume,LVEDV)等参数,并计算左心室舒张末期容积增长率。根据是否发生左心室重构,将所有研究对象划分为非重构组(△LVEDV<20%,n=72)和重构组(△LVEDV>20%,n=28)。做24h时BNP水平预测术后6个月内左心室重构的受试者工作特征(receiver operating characteristic,ROC)曲线,分析BNP水平对AMI患者术后6个月内发生左心室重构的预测价值。结果AMI患者,发病24 h血浆BNP水平预测术后6个月内左心室重构的ROC曲线下面积为0.844,差异有统计学意义(P<0.05);截值为357.0 pg/ml时,预测发生左心室重构的特异性为81.9%,敏感性为75.0%。结论AMI患者发病24 h时血浆BNP水平显著升高是近期发生左心室重构的重要危险因素,可为近期左心室重构的发生提供预测价值。

Objective To investigate the predictive value of brain natriuretic peptide(BNP)levels for ventricular remodeling six months after primary percutaneous coronary intervention(p-PCI)in patients with acute myocardial infarction(AMI).Methods One hundred patients with acute ST segment elevation myocardial infarction(STEMI)were selected as the subjects,who had been treated with primary percutaneous coronary intervention(p-PCI)within 12 h of onset.The BNP levels were measured 24 hours after chest pain onset.The left ventricular end diastolic volume(LVEDV)was measured via echocardiography at the 7th day and 6th month after PCI.According to the results of echocardiography,the rate of increase of the left ventricular end diastolic volume was calculated:△LVEDV%=(the 6th month LVEDV-the 7th day LVEDV)/the 7th day LVEDV×100%.Based on this rate of increase,all the patients were divided into the ventricular remodeling group(△LVEDV>20%,n=28)and non-remodeling group(△LVEDV<20%,n=72).The receiver operating characteristic(ROC)curve was drawn to investigate the predictive value of BNP levels 24 hour after onset for ventricular remodeling within 6 months.Results The area under the ROC curve of BNP levels 24 hours after onset was 0.844 when used to predict ventricular remodeling within 6 months,P<0.05.The cut-off value was 357.0 pg/ml,sensitivity of ventricular remodeling prediction was 75.0%,and specificity was 81.9%.Conclusions The significant increase of BNP levels in plasma 24 hours after the onset of acute myocardial infarction is an important risk factor for recent left ventricular remodeling in patients,which can help predict the occurrence of recent left ventricular remodeling.