术前BNP水平对急性STEMI患者PCI术后炎症介质水平的影响

Effects of preoperative BNP level on inflammatory mediator levels in patients with acute STEMI after PCI

目的:探讨术前脑钠肽(BNP)水平对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后炎症介质水平的影响。方法:回顾性收集2022年1月至2023年1月于防城港市第一人民医院成功行PCI治疗的110例急性STEMI患者临床资料,根据术前BNP水平的中位数分为高BNP组(n=55)和低BNP组(n=55)。进一步收集患者基线资料及PCI术后72h内的相关炎症指标[C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10、IL-12、IL-37、IL-1β]及其他实验室指标,分析急性STEMI患者术前BNP水平与其PCI术后炎症介质水平的关系;同时应用系统炎症指数(SII)评估患者PCI术后72h时机体炎症情况,比较不同SII患者术前血清BNP水平;并比较不同预后患者术前血清BNP水平。结果:与低BNP组比较,高BNP组术后血清CRP[(6.61±1.07)mg/L比(7.14±1.17)mg/L]、TNF-α[(8.29±1.62)μg/L比(9.16±1.54)μg/L]、IL-6[(14.19±2.33)pg/ml比(15.18±1.81)pg/ml]、IL-10[(24.11±5.13)μg/ml比(26.34±4.81)μg/ml]、IL-12[(45.50±4.37)ng/L比(48.19±4.60)ng/L]、IL-37[(184.02±18.33)pg/ml比(195.33±18.94)pg/ml]、IL-1β[(62.09±5.47)ng/L比(64.73±6.58)ng/L]水平显著升高(P<0.05或<0.01)。Pearson直线相关性检验显示,术前血清BNP水平与STEMI患者PCI术后血清CRP、TNF-α、IL-6、IL-10、IL-12、IL-37、IL-1β水平均呈显著正相关(r=0.258~0.394,P均<0.01)。不同SII组间的术前血清BNP水平,低SII组<中SII组<高SII组,P<0.05或<0.01。与预后良好组比较,预后不良组术前血清BNP[(112.84±8.36)pg/ml比(118.63±9.71)pg/ml]水平显著升高(P=0.014);二元Logistic回归分析显示,术前血清BNP水平是STEMI患者PCI术后短期预后不良的独立危险因素(OR=1.082,95%CI:1.014-1.155,P=0.018)。结论:术前血清BNP与急性STEMI患者术后炎症介质水平、短期预后不良有关。

Objective:To investigate the effects of preoperative brain natriuretic peptide(BNP)level on the levels of inflammatory mediators in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:The clinical data of 110 acute STEMI patients who underwent successful PCI in First People's Hospital of Fangchenggang City from January 2022 to January 2023 were retrospectively collected.According to the median preoperative BNP level,they were divided into high BNP group(n=55)and low BNP group(n=55).The baseline data and related inflammatory indicators[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-10,IL-12,IL-37,IL-1β]and other laboratory indicators within 72h after PCI were further collected to analyze the relationship between preoperative BNP level and inflammatory mediator levels after PCI in acute STEMI patients.Meanwhile,the systemic inflammation index(SII)was used to evaluate the inflammation state at 72h after PCI,and preoperative serum BNP level was compared among patients with different SII values.Preoperative serum BNP level was compared between patients with different prognosis.Results:Compared with low BNP group,there were significant rise in postoperative serum levels of CRP[(6.61±1.07)mg/L vs.(7.14±1.17)mg/L],TNF-α[(8.29±1.62)μg/L vs.(9.16±1.54)μg/L],IL-6[(14.19±2.33)pg/ml vs.(15.18±1.81)pg/ml],IL-10[(24.11±5.13)μg/ml vs.(26.34±4.81)μg/ml],IL-12[(45.50±4.37)ng/L vs.(48.19±4.60)ng/L],IL-37[(184.02±18.33)pg/ml vs.(195.33±18.94)pg/ml]and IL-1β[(62.09±5.47)ng/L vs.(64.73±6.58)ng/L]in high BNP group(P<0.05 or<0.01).Pearson linear correlation test indicated that preoperative serum BNP level was significant positively correlated with serum levels of CRP,TNF-α,IL-6,IL-10,IL-12,IL-37 and IL-1β in STEMI patients after PCI(r=0.258~0.394,P<0.01 all).Preoperative serum BNP level among different SII groups:low SII group<medium SII group<high SII group,P<0.05 or<0.01.Compared with good prognosis group,there was significant rise in preoperative serum BNP level[(112.84±8.36)pg/ml vs.(118.63±9.71)pg/ml]in poor prognosis group(P=0.014).Binary Logistic regression analysis suggested that preoperative serum BNP level was an independent risk factor for short-term poor prognosis in STEMI patients after PCI(OR=1.082,95%CI:1.014-1.155,P=0.018).Conclusion:Preoperative serum BNP is associated with postoperative inflammatory mediator levels and short-term poor prognosis in acute STEMI patients.