NT-proBNP与hs-cTnT比值对急性心肌梗死早期诊断及短期预后评估的价值研究

Value of NT-proBNP/hs-cTnT in the Diagnosis of AMI and Its Relationship with Short-term Prognosis of Patients with AMI

目的:探讨N末端脑钠肽前体(NT-proBNP)与超敏肌钙蛋白T(hs-cTnT)比值(NT-proBNP/hs-cTnT)诊断急性心肌梗死(AMI)的价值及其与AMI患者短期预后的关系。方法:回顾性选取2021年7月—2022年6月阳江市人民医院收治的124例AMI患者作为AMI组,另外选取同期收治的97例不稳定型心绞痛患者作为心绞痛组。检查所有研究对象NT-proBNP、hs-cTnT水平,计算NT-proBNP/hs-cTnT。AMI患者进行经皮冠脉介入术(PCI)治疗,观察AMI组PCI术后1年随访期间的预后情况,根据主要不良心血管事件(MACE)发生情况将其分为MACE组及非MACE组。收集AMI组入院时一般资料及疾病情况。比较AMI组及心绞痛组NT-pro BNP、hs-c Tn T水平及其比值。分析NT-pro BNP、hs-c Tn T水平及其比值诊断AMI的价值。对AMI患者不良预后的发生进行单因素及多因素分析。结果:AMI组NT-pro BNP、hs-c Tn T水平均高于心绞痛组,NT-proBNP/hs-cTnT低于心绞痛组,差异有统计学意义(P<0.05)。NT-proBNP/hs-cTnT诊断AMI与不稳定型心绞痛的ROC曲线下面积(AUC)值大于NT-proBNP、hs-cTnT单独诊断。AMI组PCI术后随访期间,23例出现MACE,其中14例出现再发性心绞痛、3例再次出现心肌梗死、2例出现心力衰竭、2例出现心律失常、2例出现心源性脑卒中。MACE组术后LVEF、血栓抽吸率低于非MACE组,NT-proBNP、hs-cTnT水平均高于非MACE组,NT-proBNP/hs-cTnT低于非MACE组,差异有统计学意义(P<0.05)。NT-proBNP、hs-cTnT高水平是AMI患者PCI术后发生不良预后的独立危险因素,差异有统计学意义(P<0.05),术后LVEF高、NT-pro BNP/hs-c Tn T高、血栓抽吸是AMI患者PCI术后的保护性因素,差异有统计学意义(P<0.05)。结论:NT-proBNP/hs-cTnT在鉴别诊断AMI与不稳定型心绞痛方面具有一定的价值,并且与AMI患者PCI术后不良短期预后密切相关,AMI患者短期预后影响因素较多。

Objective:To investigate the value of N-terminal brain natriuretic peptide(NT-proBNP)/high-sensitivity troponin T(hs-cTnT)in the diagnosis of acute myocardial infarction(AMI)and its relationship with short-term prognosis of patients with AMI.Method:A total of 124 patients with AMI admitted to Yangjiang People's Hospital from July 2021 to June 2022 were retrospectively selected as AMI group,and 97 patients with unstable angina at the same period were selected as angina group.The levels of NT-proBNP and hs-cTnT were examined in all research objects,and the NT-proBNP/hs-cTnT was calculated.AMI patients were treated with percutaneous coronary intervention(PCI).The prognosis condition of AMI group during 1-year follow-up after PCI was observed,and they were divided into MACE group and non-MACE group according to the occurrence condition of major adverse cardiovascular events(MACE).The general information and disease status of AMI group at admission were collected.The levels of NT-proBNP and hs-cTnT and their ratio were compared between AMI group and angina group.The value of NT-proBNP and hs-cTnT levels and their ratios in the diagnosis of AMI was analyzed.Univariate and multivariate analysis were performed to analyze the occurrence of poor prognosis in AMI patients.Result:The levels of NT-proBNP and hs-cTnT in AMI group were higher than those in angina group,and the value of NT-proBNP/hs-cTnT was lower than that in angina group,and the differences were statistically significant(P<0.05).The area under ROC curve(AUC)value of NT-proBNP/hs-cTnT in the diagnosis of AMI and unstable angina pectoris was greater than that of NT-proBNP and hs-cTnT alone.During the follow-up period after PCI in AMI group,23 patients had MACE,including 14 patients with recurrent angina,3 patients with recurrent myocardial infarction,2 patients with heart failure,2 patients with arrhythmia,and 2 patients with cardiogenic stroke.The LVEF after operation and thrombus aspiration rate in the MACE group were lower than those in the non-MACE group,the levels of NT-proBNP and hs-cTnT were higher than those in the non-MACE group,and the NT-proBNP/hs-cTnT was lower than that in the non-MACE group,and the differences were statistically significant(P<0.05).High levels of NT-proBNP and hs-cTnT were independent risk factors for poor prognosis of AMI patients after PCI,the differences were statistically significant(P<0.05).High postoperative LVEF,high NT-proBNP/hs-cTnT and thrombus aspiration were protective factors for AMI patients after PCI,the differences were statistically significant(P<0.05).Conclusion:NT-proBNP/hs-cTnT has a certain value in the differential diagnosis of AMI and unstable angina aspect,and it is closely related to the poor short-term prognosis of patients with AMI after PCI.There are many factors affecting short-term prognosis of AMI patients.