血清NT-proBNP、MMP-9对AMI患者急诊PCI术后ST段回落的预测价值

Predictive value of serum NT-proBNP and MMP-9 for ST segment depression after emergency PCI in patients with AMI

目的探讨血清N末端B型利钠肽原(NT-proBNP)、基质金属蛋白酶-9(MMP-9)对急性心肌梗死(AMI)患者急诊经皮冠脉介入治疗(PCI)术后ST段回落的预测价值。方法收集2019年3月至2021年4月在安徽医科大学第二附属医院接受急诊PCI治疗的96例AMI患者,对入选患者的相关资料进行回顾性分析。依据PCI术后ST段回落监测结果,分为正常组(ST段回落≥50%)61例和研究组(ST段回落<50%)35例。比较两组临床资料和入院时血清NT-proBNP、MMP-9水平,运用多因素Logistic回归模型和受试者工作特征(ROC)曲线分析的方法,分析入院时血清NT-proBNP、MMP-9水平与ST段回落不良的关系及预测价值。结果研究组左心室射血分数(LVEF)为(52.87±4.58)%,低于正常组[(56.77±4.61)%],发病至PCI时间、血清NT-proBNP、MMP-9水平分别为(6.30±2.26)h、(4076.43±1239.26)pg/mL、(851.28±136.07)ng/L,高于正常组[(5.27±2.18)h、(2457.93±846.26)pg/mL、(726.58±118.43)ng/L],差异均有统计学意义(P<0.05)。发病至PCI时间(OR=1.375,95%CI:1.132~1.648)、NT-proBNP(OR=2.836,95%CI:1.729~3.943)和MMP-9(OR=1.947,95%CI:1.235~2.659)是AMI患者急诊PCI术后ST段回落不良的独立影响因素(P<0.05);ROC曲线显示,入院时血清NT-proBNP、MMP-9水平预测AMI患者急诊PCI术后ST段回落不良的曲线下面积(AUC)为0.847、0.803,截断值为2769.83 pg/mL、819.52 ng/L,敏感度为83.61%、75.41%,特异度为75.41%、80.00%。结论入院时血清NT-proBNP、MMP-9水平对AMI患者急诊PCI术后ST回落不良具有预测价值,为临床筛查高危患者和及时干预提供依据。

Objective To investigate the predictive value of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)and matrix metalloproteinase-9(MMP-9)for ST segment depression after emergency percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods From March 2019 to April 2021,96 patients with AMI who received emergency PCI treatment in the Second Affiliated Hospital of Anhui Medical University were collected,and the relevant data of the selected patients were retrospectively analyzed.According to the monitoring results of ST depression after PCI,they were divided into normal group(61 cases with ST segment depression≥50%)and study group(35 cases with ST segment depression<50%).The clinical data and serum NT proBNP and MMP-9 levels at admission were compared between the two groups.The relationship between serum NT proBNP and MMP-9 levels at admission and poor ST segment resolution were analyzed by multivariate logistic regression model and receiver operating characteristic curve(ROC)analysis.Results The left ventricular ejection fraction(LVEF)in the study group was(52.87±4.58)%,which was lower than those in the normal group[(56.77±4.61)%],and time from onset to PCI,the levels of serum NT proBNP,MMP-9 were(6.30±2.26)h,(4076.43±1239.26)pg/mL,(851.28±136.07)ng/L,which were higher than those in the normal group[(5.27±2.18)h,(2457.93±846.26)pg/mL,(726.58±118.43)ng/L],the differences were statistically significant(P<0.05).The time from onset to PCI(OR=1.375,95%CI:1.132-1.648),NTproBNP(OR=2.836,95%CI:1.729-3.943)and MMP-9(OR=1.947,95%CI:1.235-2.659)were the independent influencing factors of poor ST segment resolution in AMI patients after emergency PCI(P<0.05).ROC curve showed that the area under the curve(AUC)of serum NT proBNP and MMP-9 levels in predicting poor ST segment resolution in AMI patients after emergency PCI were 0.847 and 0.803,the cut-off values were 2769.83 pg/mL and 819.52 ng/L,the sensitivity was 83.61%,75.41%,and the specificity was 75.41%and 80.00%.Conclusion The serum levels of NT proBNP and MMP-9 at admission have predictive value for poor ST resolution in patients with AMI after emergency PCI,and provide basis for clinical screening of high-risk patients and timely intervention.