血浆BNP联合cTnT和D-二聚体预测PCI术后近期不良预后的效能探讨

Predictive effect of plasma brain natriuretic peptide combined with cTnT and D-Dimer on short-term adverse prognosis after PCI

目的:观察血浆BNP联合cTnT、D-二聚体在预测PCI术后近期不良预后的效能。方法:以152例因急性ST段抬高型心肌梗死接受PCI治疗的病例为研究对象。记录PCI术后近期(3个月)不良预后情况,分析预后不良者与预后良好者的基线资料及血浆病情相关指标差异,采用多因素回归分析法分析预后不良的影响因素,以ROC曲线图进行指标临床预后预测效能分析。结果:152例PCI患者术后3月预后不良率为17.11%(26例),预后不良者与预后良好者在血压(收缩压、舒张压)、是否吸烟、血浆病情相关指标(cTnT、D-二聚体、BNP)上比较(P<0.05)。BNP、cTnT、D-二聚体均是PCI术后近期预后不良的危险因素(OR=2.156,1.522,1.565;均P<0.05)。ROC曲线分析显示:BNP、cTnT、D-二聚体三者联合预测不良预后的敏感度(92.74%)、特异度(90.73%)、准确性(89.78%)均优于单纯BNP(75.63%、74.48%、69.83%)、单纯cTnT(72.12%、74.38%、70.79%)、单纯D-二聚体(72.12%、74.38%、70.79%)(P<0.05)。结论:血清cTn、BNP、D-二聚体水平均可对PCI术的近期不良预后产生影响,相比与单纯BNP、单纯cTnT、单纯D-二聚体,三者联合的PCI术后近期不良预后的预测效能更佳。

Objective:To observe the effect of plasma BNP combined with cTnT and D-Dimer in predicting the short-term adverse prognosis after PCI.Method:A total of 152 patients with ST-segment elevation myocardial infarction(ST-segment elevation myocardial infarction)were treated with PCI(time range:2018.1-2018.12).The short-term(3 months)adverse prognosis after PCI was recorded,and the baseline data and plasma disease-related indicators of patients with poor prognosis and good prognosis were analyzed.Multivariate regression analysis was used to analyze the influencing factors of poor prognosis,and ROC curve was used to analyze the predictive efficacy of clinical prognosis.Result:The poor prognosis rate of 152 patients with PCI was 17.11%(26 cases)in 3 months after operation.The poor prognosis patients were compared with those with good prognosis in blood pressure(systolic blood pressure,diastolic blood pressure),smoking or not,plasma disease-related indicators(cTnT,D-Dimer,BNP)(P<0.05).BNP,cTnT and D-Dimer were risk factors for poor prognosis after PCI(OR=2.156,1.522,1.565;P<0.05).ROC curve analysis showed that the sensitivity(92.74%),specificity(90.73%)and accuracy(89.78%)of BNP,cTnT and D-Dimer were better than those of BNP alone(75.63%,74.48%,69.83%),cTnT alone(72.12%,74.38%,70.79%)and D-Dimer alone(72.12%,74.38%,70.79%)(P<0.05).Conclusion:Serum levels of cTn,BNP and D-Dimer can affect the short-term adverse prognosis of PCI.Compared with BNP,cTnT and D-Dimer alone,the combination of them has better predictive effect on the short-term adverse prognosis of PCI.