不同血清学指标联合诊断在急性心肌梗死患者PCI后心功能中的预测价值

Predictive value of combined diagnosis of different serum indicators in cardiac function after PCI in patients with acute myocardial infarction

目的探讨不同血清学指标联合诊断在急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后心功能中的预测价值,为临床早期干预提供参考。方法选取2020年3年至2022年5月该院收治的106例行PCI后AMI患者作为观察组,根据PCI后心功能Killip分级,将其分为KillipⅠ级组(50例)、KillipⅡ级组(36例)和KillipⅢ级组(20例);另选取同期106例健康体检者作为对照组。分析不同心功能Killip分级患者基线资料,以及各级研究对象的血清脂肪酸结合蛋白4(FABP4)、D-二聚体(D-D)、降钙素原(PCT)、脑钠肽(BNP)及C反应蛋白(CRP)水平的差异;分析各血清学指标与心功能Killip分级的相关性,采用多因素Logistic回归分析AMI患者心功能KillipⅢ级的相关危险因素,采用受试者工作特征(ROC)曲线分析血清学指标对AMI患者PCI后心功能KillipⅢ级的预测价值。结果不同心功能分级AMI患者年龄比较,差异有统计学意义(P<0.05);血清FABP4、D-D、PCT、BNP及CRP水平比较,对照组<KillipⅠ级组<KillipⅡ级组<KillipⅢ级组,差异均有统计学意义(P<0.05);血清FABP4、D-D、PCT、BNP及CRP水平与心功能Killip分级均呈正相关(r=0.722、0.726、0.749、0.828、0.681,P<0.05);年龄增大及血清FABP4、D-D、PCT、BNP和CRP水平升高是AMI患者PCI后心功能KillipⅢ级的危险因素(P<0.05);血清FABP4、PCT、D-D、CRP及BNP联合预测PCI后心功能KillipⅢ级的ROC曲线下面积(AUC)为0.928(95%CI:0.862~0.969),大于各项血清学指标单独预测。结论血清FABP4、PCT、D-D、CRP及BNP水平与AMI患者PCI后心功能状态密切相关,多项血清指标联合检测对AMI患者PCI后心功能KillipⅢ级具有较高预测价值,可用于评估AMI患者心功能预后。

Objective To investigate the predictive value of the combined diagnosis of different serum indicators in cardiac function after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI),and to provide reference for early clinical intervention.Methods A total of 106 patients with AMI underwent PCI admitted to this hospital from March 2020 to May 2022 were selected as observation group,who were divided into Killip gradeⅠgroup(50 cases),Killip gradeⅡgroup(36 cases)and Killip gradeⅢgroup(20 cases)according to the Killip grade of cardiac function after PCI,and 106 healthy physical examination patients during the same period were selected as control group.The baseline data of patients with different Killip grades of cardiac function and the differences in serum fatty acid binding protein 4(FABP4),D-dimer(D-D),procalcitonin(PCT),brain natriuretic peptide(BNP)and C-reactive protein(CRP)levels of subjects at different grades were analyzed.The relationship between each serum indicator and cardiac function Killip classification was analyzed.Multivariate logistic regression analysis was used to analyze the related risk factors of cardiac function Killip gradeⅢin AMI patients,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum indicators to predict Killip gradeⅢof cardiac function in AMI patients after PCI.Results The age of AMI patients with different cardiac function grades was compared,and the difference was statistically significant(P<0.05).When comparing serum FABP4,D-D,PCT,BNP and CRP levels,control group<Killip gradeⅠgroup<Killip gradeⅡgroup<Killip gradeⅢgroup,and the differences were statistically significant(P<0.05).Serum FABP4,D-D,PCT,BNP and CRP levels were positively correlated with cardiac function Killip classification relationship(r=0.722,0.726,0.749,0.828,0.681,P<0.05).Increasing age and elevated levels of serum FABP4,D-D,PCT,BNP and CRP were risk factors for Killip gradeⅢof cardiac function after PCI in patients with AMI(P<0.05).The area under the ROC curve(AUC)value of serum FABP4,PCT,D-D,CRP and BNP combined to predict Killip gradeⅢof cardiac function after PCI was 0.928(95%CI:0.862-0.969),which was better than that predicted by each serum index alone.Conclusion Serum PCT,D-D,CRP and BNP levels are closely related to the status of cardiac function after PCI in AMI patients,and the combined detection of multiple serum indicators has a high predictive value for Killip gradeⅢof cardiac function after PCI in AMI patients,which can assess the prognosis of cardiac function in AMI patients.