NT-proBNP、Lp(a)和PDW水平与急性心肌梗死经皮冠状动脉介入治疗后并发心力衰竭的关系分析

Association between NT-proBNP,Lp(a)and PDW levels and concurrent heart failure after percutaneous coronary intervention of acute myocardial infarction

目的探究N末端B型利钠肽原(NT-proBNP)、脂蛋白a[Lp(a)]和血小板分布宽度(PDW)水平与急性心肌梗死经皮冠状动脉介入治疗后并发心力衰竭的关系。方法回顾性选取2020年1月至2022年1月国药同煤总医院收治的160例行经皮冠状动脉介入治疗的急性心肌梗死患者为研究组,另选同期国药同煤总医院进行体检的健康志愿者160例为对照组。分析两组的NT-proBNP、Lp(a)和PDW水平。对研究组患者进行1年随访,记录患者是否发生心力衰竭,并根据随访结果将研究组患者分为并发心力衰竭组(n=42)及未发心力衰竭组(n=118),收集患者基本资料进行单因素及多因素分析。并采用受试者工作特征(ROC)曲线对其NT-proBNP、Lp(a)和PDW水平进行分析,探究其对急性心肌梗死经皮冠状动脉介入治疗后患者并发心力衰竭的预测价值。结果研究组NT-proBNP、Lp(a)、PDW水平分别为(1721.13±221.25)pg/mL、(25.44±10.21)mg/dL、(17.98±2.54)%,均高于对照组[(220.13±56.23)pg/mL、(16.55±9.87)mg/dL、(13.55±2.33)%],差异均有统计学意义(P<0.05)。并发心力衰竭组患者的年龄、有糖尿病史患者比率、急性前壁性患者比率、NT-proBNP、Lp(a)和PDW水平分别为(59.29±9.98)岁、78.57%、38.10%、(2216.26±316.59)pg/mL、(43.05±1.26)mg/dL、(20.46±1.38)%,均高于未发心力衰竭组[(55.45±8.14)岁、28.81%、16.95%、(1933.29±251.36)pg/mL、(29.44±1.64)mg/dL、(16.54±1.12)%],差异均有统计学意义(P<0.05)。经二元Logistic回归分析,年龄、糖尿病史、NT-proBNP、Lp(a)和PDW水平为患者术后发生心力衰竭的危险因素(P<0.05)。患者NT-proBNP、Lp(a)和PDW水平对术后并发心力衰竭的诊断价值曲线下面积(AUC)值分别为0.766、0.884、0.984。结论NT-proBNP、Lp(a)和PDW水平在急性心肌梗死经皮冠状动脉介入治疗后并发心力衰竭患者中表达上调,对其术后并发心力衰竭具有一定诊断价值。

Objective To explore the relationship of N-terminal B natriuretic peptide(NT-proBNP),lipoprotein(a)[Lp(a)],and the level of platelet distribution width(PDW)and concurrent heart failure after percutaneous coronary intervention of acute myocardial infarction.Methods A total of 160 patients who underwent percutaneous coronary intervention for acute myocardial infarction were retrospectively selected as the study group from Sinophyarm Tongmei General Hospital between January 2020 and January 2022.Additionally,160 healthy volunteers who underwent physical examinations at the same hospital during the same period were chosen as the control group.The levels of NT-proBNP,Lp(a),and PDW were analyzed in two groups.The study group patients were followed up for one year to record the incidence of heart failure.Based on the follow-up results,they were divided into two subgroups:those who developed heart failure(n=42)and those who did not(n=118).Basic information of the patients was collected for univariate and multivariate analysis.The levels of NT-proBNP,Lp(a),and PDW,exploring their predictive value for heart failure complications in patients with acute myocardial infarction after percutaneous coronary intervention was analyzed by using receiver operating characteristic(ROC)curve.Results The levels of NT-proBNP,Lp(a)and PDW in the study group were(220.13±56.23)pg/mL,(16.55±9.87)mg/dL,(13.55±2.33)%,which were higher than those in the control group[(1721.13±221.25)pg/mL,(25.44±10.21)mg/dL,(17.98±2.54)%],the differences were statistically significant(P<0.05).The age of patients with heart failure,the rate of patients with a history of diabetes,the rate of patients with acute anterior wall,NT-proBNP,Lp(a)and PDW levels were(59.29±9.98)years,78.57%,38.10%,(2216.26±316.59)pg/mL,(43.05±1.26)mg/dL,(20.46±1.38)%,respectively,which were higher than those in the non heart failure group[(55.45±8.14)years old,28.81%,16.95%,(1933.29±251.36)pg/mL,(29.44±1.64)mg/dL,(16.54±1.12)%)],and the differences were statistically significant(P<0.05).By binary Logistic regression analysis,age,diabetes history,NT-proBNP,Lp(a)and PDW levels were the risk factors for postoperative heart failure(P<0.05).The diagnostic value curve area values of NT-proBNP,Lp(a),and PDW levels in patients with postoperative heart failure were 0.766,0.884,and 0.984,respectively.Conclusion NT-proBNP,Lp(a)and PDW levels are up-regulated in patients with heart failure after percutaneous coronary intervention of acute myocardial infarction,which has some diagnostic value for postoperative heart failure.