血浆氨基末端脑钠肽前体、D-二聚体浓度与急性ST段抬高型心肌梗死患者PCI治疗后左心室血栓发生的关系

Relationship between Plasma Concentrations of N-Terminal Pro-Brain Natriuretic Peptide,D-Dimer Levels and Left Ventricular Thrombosis after Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction

目的分析血浆氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、D-二聚体(D-dimer,D-D)浓度与急性ST段抬高型心肌梗死(ST segment-elevation myocardial infarction,STEMI)患者PCI治疗后发生左心室血栓(left ventricular thrombosis,LVT)的关系。方法选取泰州市人民医院2019年11月至2021年11月收治的120例STEMI患者作为研究对象,患者均在医院接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,于治疗后2周内行超声检查,根据患者LVT发生情况分为LVT组和非-LVT组。PCI治疗前收集患者临床资料并检测相关实验室指标[血糖(blood glucose,BG)、糖化血红蛋白(glycosylated hemoglobin,GHb)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、高密度脂蛋白胆固醇(high-density lipo⁃protein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、NT-proBNP、D-D、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoen⁃zyme,CK-MB)等],分析各指标与STEMI患者PCI治疗后发生LVT的关系,重点检验血浆NT-proBNP、D-D浓度对STEMI患者PCI治疗后发生LVT的预测效能。结果PCI治疗后2周内发生LVT的患者占18.33%,未发生LVT的患者占81.67%;LVT组患者心功能Killip分级Ⅲ级占比多于非-LVT组,入院时左心室射血分数(left ventricular ejection fraction,LVEF)低于非-LVT组,差异有统计学意义(P<0.05);LVT组患者的全血BG、GHb、TC、TG浓度高于非-LVT组,血浆NT-proBNP、D-D浓度高于非-LVT组,差异有统计学意义(P<0.05)。Pearson直线相关性检验结果显示,LVEF、BG、GHb、TC、TG、NT-proBNP、D-D与STEMI患者PCI治疗后发生LVT呈正相关(r>0,P<0.05)。受试者工作特征(ROC)曲线分析结果显示,单独及联合预测STEMI患者PCI治疗后发生LVT的曲线下面积(AUC)分别为0.798、0.795、0.884,均有一定预测价值。限制性立方样条分析结果显示,血浆NT-proBNP、D-D浓度与STEMI患者PCI治疗后发生LVT呈线性剂量反应关系(P<0.05)。结论血浆高NT-proBNP、D-D浓度与STEMI患者PCI治疗后发生LVT有关,随着血浆NT-proBNP、D-D浓度升高,患者PCI治疗后LVT发生的风险呈递增趋势,联合检测血浆NT-proBNP、D-D浓度可预测PCI治疗后LVT发生的风险。

Objectives To analyze the relationship between plasma concentrations of N-terminal pro-brain natriuretic peptide(NT-proBNP),D-dimer(D-D)and left ventricular thrombosis(LVT)in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods Totally 120 patients with STEMI treated in Taizhou People′s Hospital from November 2019 to November 2021 were selected.All the patients received PCI in the hospital,and ultrasound examination was performed within 2 weeks after PCI.According to the occur⁃rence of LVT,patients were divided into LVT group and non-LVT group.The clinical data of patients were collected before PCI and the relevant laboratory indexes[blood glucose(BG),glycosylated hemoglobin(GHb),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDLC),NT-proBNP,D-D,lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),etc.]were detected.The relationships between each index and LVT after PCI in patients with STEMI was analyzed.The predic⁃tive efficacy of plasma concentrations of NT-proBNP and D-D on LVT after PCI in patients with STEMI was mainly test⁃ed.Results Among the 120 patients with STEMI,18.33%patients had LVT within 2 weeks after PCI,and 81.67%patients did not have LVT.The proportion of patients with Killip grade III in LVT group was higher than that in non-LVT group,and the left ventricular ejection fraction(LVEF)at admission was lower than that in non-LVT group,the differ⁃ences between which were statistically significant(P<0.05).The concentrations of whole blood BG,GHb,TC and TG in LVT group were higher than those in non-LVT group,and the plasma concentrations of NT-proBNP and D-D in LVT group were higher than those in non-LVT group,the differences between which were statistically significant(P<0.05).Pearson linear correlation test showed that LVEF,BG,GHb,TC,TG,NT-proBNP and D-D positively correlated with LVT after PCI in patients with STEMI(r>0,P<0.05).The receiver operating characteristic(ROC)curve was drawn and showed that,the area under the curve(AUC)for predicting LVT after PCI in patients with STEMI alone and in combina⁃tion were 0.798,0.795 and 0.884,respectively,with certain predictive value.Through restricted cubic spline analysis,the results showed that,there was a linear dose-response relationship between plasma concentrations of NT-proBNP,D-D and LVT after PCI in patients with STEMI(P<0.05).Conclusions The high plasma concentrations of NT-proBNP and D-D relate to LVT after PCI in patients with STEMI.With the increasing of plasma concentrations of NT-proBNP and D-D,the risk of postoperative LVT of patients increases.Combined detection of plasma concentrations of NT-proBNP and D-D can predict the risk of postoperative LVT.