超声心肌活动指数结合血清NT-proBNP、cTnI水平对ACS患者PCI术后并发心力衰竭的预测分析

Predictive analysis of ultrasonic myocardial activity index combined with serum NT-proBNP and cTnI levels on heart failure in patients with ACS after PCI

目的探讨超声心肌活动指数(Tei指数)结合血清N末端B型钠尿肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗术(PCI)术后并发心衰的预测价值。方法选取2018年10月至2020年11月本院收治的拟行PCI治疗的249例ACS患者为观察组,另选取同期健康体检者215例为对照组。2组均行超声心动图检查Tei指数,采用酶联免疫法(ELISA)检测血清NT-proBNP、cTnI水平。随访6个月,统计观察组患者PCI术后心衰发生率,根据观察组患者PCI术后是否并发心衰而将其分为并发组与未并发组,比较此2组患者上述指标;分析上述指标与ACS患者PCI术后并发心衰的关系及各指标单独、联合对并发心衰的预测价值。结果观察组超声Tei指数及血清NT-proBNP、cTnI水平均高于对照组(P<0.05);观察组心衰并发率为19.28%;并发组Tei指数及血清NT-proBNP、cTnI水平均高于未并发组(P<0.05);年龄、冠状动脉Gensini评分、合并糖尿病、低密度脂蛋白胆固醇(LDL-C)、尿酸、Tei指数、血清NT-proBNP与cTnI水平均是ACS患者PCI术后并发心衰的危险因素(OR=5.824、6.284、6.012、6.586、15.705、6.309、15.090、6.508,P<0.05);Tei指数结合血清NT-proBNP、cTnI水平对ACS患者PCI术后并发心衰的灵敏度高于单独预测(P<0.05),AUC也高于单独预测(P<0.05),特异度与单独预测比较差异无统计学意义(P>0.05)。结论ACS患者较健康人群Tei指数增大、血清NT-proBNP与cTnI水平升高,且上述指标与年龄、冠状动脉Gensini评分、合并糖尿病、LDL-C、尿酸均是ACS患者PCI术后并发心衰的危险因素,且Tei指数结合NT-proBNP、cTnI水平对ACS患者PCI术后并发心衰的预测效能理想,可推广应用于临床。

Objective To investigate the predictive values of ultrasonic myocardial activity index(Tei index)combined with serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)and cardiac troponin I(cTnI)levels in patients with acute coronary syndrome(ACS)complicated with heart failure after percutaneous coronary intervention(PCI).Methods 249 ACS patients who were treated by PCI admitted to our hospital from October 2018 to November 2020 were selected as the observation group,and another 215 healthy people in the same period were selected as the control group.Tei index was detected by echocardiography,and enzyme linked immunosorbent assay(ELISA)was used to detect serum NT proBNP and cTnI levels.All patients were followed up for 6 months,and the incidence of heart failure after PCI in the observation group was statistically analyzed,and the patients in the observation group were divided into concurrent group and non-concurrent group according to whether they had heart failure after PCI,and the above indexes were compared between two groups.The relationships between the above indexes and heart failure in patients with ACS after PCI and the predictive values of every index alone or combined for heart failure were analyzed.Results The ultrasonic Tei index and serum NT proBNP and cTnI levels of the observation group were higher than those of the control group(P<0.05).The incidence of heart failure in the observation group was 19.28%.The incidence of adverse outcomes in the concurrent group was 52.08%,which was significantly higher than that in the non concurrent group(P<0.05).Tei index and serum NT proBNP and cTnI levels in the concurrent group were higher than those in the non-concurrent group(P<0.05).Age,coronary Gensini score,combined with diabetes mellitus,low density lipoprotein cholesterol(LDL-C),uric acid,ultrasound Tei index,serum NT proBNP and cTnI levels were risk factors of heart failure in ACS patients after PCI(OR=5.824,6.284,6.012,6.586,15.705,6.309,15.090,6.508,P<0.05).The sensitivity of Tei index combined with serum NT proBNP and cTnI levels in predicting heart failure of ACS patients after PCI was higher than that of single prediction(P<0.05),AUC was also higher than that of single prediction(P<0.05),but there was no significant difference in specificity between combined prediction and single prediction(P>0.05).Conclusion Tei index and serum NT proBNP and cTnI levels in patients with ACS are higher than those in healthy people,and the above indexes and age,coronary Gensini score,combined with diabetes mellitus,LDL-C,and uric acid are the risk factors of heart failure.The Tei index combined with NT proBNP and cTnI level can effectively predict heart failure in ACS patients after PCI,which can be widely used in clinic.