AMI合并HF患者血清cTnI、MYO、CK-MB与心力衰竭分级、心室重塑及预后关系

The relationship between serum cTnI,MYO,CK-MB and heart failure grade,ventricular remodeling and prognosis in patients with AMI and HF

目的 分析急性心肌梗死(AMI)合并心力衰竭(HF)患者血清心肌钙蛋白(cTnI)、肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)水平变化及与心力衰竭分级、心室重塑及预后关系。方法 前瞻性随机选取2022年3月—2023年12月淮南东方医院集团总医院71例AMI合并HF患者(AMI合并HF组)及同期46例单纯AMI患者(单纯AMI组),对比两组基线资料及血清cTnI、MYO、CK-MB水平差异,将AMI合并HF患者根据Killip心力衰竭分级评估法分为Ⅱ级10例、Ⅲ级42例、Ⅳ级19例,比较不同心力衰竭分级患者血清cTnI、MYO、CK-MB水平及心室重塑指标[左心室舒张末内径(LVEDD)、舒张末左心室后壁厚度(PWT)、舒张末期室间隔厚度(IVSD)、左室射血分数(LVEF)、左心室质量分数(LVMI)];采用Pearson相关分析法探究血清cTnI、MYO、CKMB水平与心室重塑指标相关性;绘制受试者工作特征曲线(ROC)探究血清cTnI、MYO、CK-MB对出院后1年内心血管终点事件预测价值。结果 AMI合并HF组与单纯AMI组基线资料比较差异均无统计学意义(P>0.05);AMI合并HF组血清cTnI、MYO、CK-MB水平均较单纯AMI组明显升高(P<0.05);不同心力衰竭分级AMI合并HF患者血清cTnI、MYO、CK-MB水平及LVEDD、IVSD、LVEF、LVMI水平比较差异均有统计学意义(P<0.05),其中cTnI、CK-MB、IVSD、LVMI均表现为Ⅳ级>Ⅲ级>Ⅱ级(P<0.05),MYO在Ⅳ级中较Ⅲ级、Ⅱ级明显升高(P<0.05),LVEDD在Ⅳ级、Ⅲ级中较Ⅱ级明显升高(P<0.05),LVEF表现为Ⅳ级<Ⅲ级<Ⅱ级(P<0.05)。Pearson相关性分析显示,血清cTnI、MYO、CK-MB均与LVEDD、IVSD、LVMI呈正相关(P<0.05),与LVEF呈负相关(P<0.05)。随访1年内,32例(45.07%)发生心血管终点事件,其中事件组血清cTnI、CK-MB水平明显高于非事件组(P<0.05)。血清cTnI、CK-MB水平预测心血管终点事件的ROC曲线下面积分别为0.848、0.886(P<0.05)。结论 AMI后HF患者血清cTnI、MYO、CK-MB水平明显升高,且与心功能、心室重塑相关,其中cTnI、CK-MB对心血管终点事件有一定预测价值。

Objective To analyze the changes in levels of serum cardiac troponin(cTnI),myoglobin(MYO)and creatine kinase isoenzyme-MB(CK-MB)in patients with acute myocardial infarction(AMI)complicated with heart failure(HF)and their relationship with heart failure grading,ventricular remodeling and prognosis.Methods 71 patients with AMI and HF(AMI with HF group)and 46 patients with simple AMI(simple AMI group)were enrolled between March 2022 and December 2023,and the baseline data and serum levels of cTnI,MYO and CK-MB were compared between the two groups.According to the Killip grading assessment of heart failure,the patients AMI and HF were divided into 10 cases of gradeⅡ,42 cases of gradeⅢand 19 cases of gradeⅣ.Levels of serum cTnI,MYO and CK-MB,and ventricular remodeling indicators[left ventricular end diastolic diameter(LVEDD),left ventricular end diastolic posterior wall thickness(PWT),end diastolic ventricular septal thickness(IVSD),left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI)]were compared among patients with different heart failure grades.Pearson correlation analysis was used to explore the correlation between levels of serum cTnI,MYO and CK-MB and ventricular remodeling indicators.Receiver operating characteristic curve(ROC)was drawn to explore the predictive value of serum cTnI,MYO and CK-MB on cardiovascular endpoint events within 1 year after discharge.Results There were no statistical differences in baseline data between AMI with HF group and simple AMI group(P>0.05).Serum levels of cTnI,MYO,and CK-MB in AMI with HF group were significantly higher than those in simple AMI group(P<0.05).Statistically significant differences were observed in the levels of serum cTnI,MYO,CK-MB,LVEDD,IVSD,LVEF,and LVMI among patients with AMI complicated with HF of different heart failure grades(P<0.05).Among them,cTnI,CK-MB,IVSD and LVMI were shown as gradeⅣ>gradeⅢ>gradeⅡ(P<0.05),and MYO in gradeⅣwas significantly higher than in gradeⅢor grade II(P<0.05),and LVEDD in gradeⅣand gradeⅢwas significantly higher than in gradeⅡ(P<0.05),and LVEF was shown as gradeⅣ<gradeⅢ<gradeⅡ(P<0.05).Pearson correlation analysis showed that serum cTnI,MYO and CK-MB were positively correlated with LVEDD,IVSD and LVMI(P<0.05),and were negatively correlated with LVEF(P<0.05).Within 1 year of follow-up,there were 32 cases of cardiovascular endpoint events(45.07%).The levels of serum cTnI and CK-MB in event group were significantly higher than those in non-event group(P<0.05).The areas under the ROC curves of serum cTnI and CK-MB in predicting cardiovascular endpoint events were 0.848 and 0.886(P<0.05).Conclusion Serum cTnI,MYO and CK-MB levels in patients with HF after AMI are increased significantly,and they are correlated with cardiac function and ventricular remodeling.cTnI and CK-MB have certain predictive value on cardiovascular endpoint events.