术前血清hsTnI、Hcy及BNP检测在心脏瓣膜置换术患者术后预后中的预测作用

Predictive role of preoperative serum hsTnI,Hcy and BNP in postoperative prognosis of patients undergoing heart valve replacement

目的 分析术前血清高敏肌钙蛋白I(hs-TnI)、同型半胱氨酸(Hcy)及脑钠肽(BNP)检测在心脏瓣膜置换术(CVR)患者术后预后中的预测作用。方法 选取2020年1月至2023年1月间郑州市第七人民医院收治的行CVR术患者132例。术后行1年随访,分析随访情况并分组;比较无不良事件组、不良事件组血清hsTnI、Hcy及BNP水平;为识别影响CVR术患者预后的独立危险因素,首先筛选NYHA分级、LVEF、hsTnI、Hcy和BNP等潜在因素,并进行单因素分析。随后,采用逐步前进法的多因素二元Logistic回归分析,深入探讨这些因素对患者预后的独立影响。结果 132例接受CVR术治疗的患者在随访终止时,101例患者未发生不良事件(即无不良事件组),31例患者发生不良事件(即不良事件组)。不良事件组中,人工瓣膜功能衰退2例、瓣周漏1例、人工瓣膜性心内膜炎1例、再次更换瓣膜1例、出血6例、血栓栓塞3例、恶性心律失常15例、出现死亡2例,共计发生率为23.48%(31/132)。不良事件组血清hsTnI、Hcy及BNP水平均显著高于无不良事件组,差异具有统计学意义(P<0.05)。单因素二元Logistic回归分析显示,NYHA分级、LVEF、hsTnI、Hcy、BNP是影响CVR患者预后的影响因素(P<0.05)。多因素二元Logistic回归分析显示,NYHA分级为Ⅲ~Ⅳ级、LVEF<45%、术前血清hsTnI、Hcy及BNP水平升高是影响CVR患者术后不良事件发生的独立危险因素(P<0.05)。结论 术前血清hsTnI、Hcy及BNP检测在CVR术患者术后预后中具有重要的预测作用,术前上述生物标志物水平升高可能提示患者存在较高的不良事件风险。因此,在临床工作中,应加强对术前血清hsTnI、Hcy及BNP的监测和评估,以便及时发现并处理潜在的风险因素,从而提高CVR术后患者的预后质量。

Objective To analyze the predictive role of preoperative serum high-sensitivity tropo-nin I(hs-TnI),homocysteine(Hcy)and brain natriuretic peptide(BNP)in patients undergoing heart valve re-placement(CVR).Methods 132 patients who underwent CVR from January 2020 to January 2023 at Zheng-zhou Seventh People’s Hospital were selected.Follow-up was performed for one-year post-operation,and the follow-up was analyzed and grouped.The levels of serum hsTnI,Hcy and BNP were compared between the non-adverse event group and the adverse event group.In order to identify the independent risk factors affecting the prognosis of patients undergoing CVR,potential factors such as NYHA grade,LVEF,hsTnI,Hcy and BNP were screened,and univariate analysis was conducted.Subsequently,stepwise multivariate binary logis-tic regression analysis was used to explore the independent influence of these factors on the prognosis of pa-tients.Results Out of the 132 patients who underwent CVR,101 experienced no adverse events at the end of the follow up period(i.e.,the no-adverse-event group)and 31 experienced adverse events(i.e.,the adverse-event group).In the adverse events group,there were 2 cases of prosthetic valve failure,1 case of perivalvular leakage,1 case of prosthetic valve endocarditis,1 case of valve replacement again,6 cases of haemorrhage,3 cases of thromboembolism,15 cases of malignant arrhythmia,and 2 cases of emergence of death,with a total incidence rate of 23.48%(31/132).Serum hsTnI,Hcy and BNP levels in the adverse-event group were signifi-cantly higher than those in the no-dverse-event group,and the difference was statistically significant(P<0.05).Based on univariate binary logistic regression analysis,the influential factors affecting the prognosis of CVR patients(P<0.05)were NYHA classification,LVEF,hsTnI,Hcy,and BNP.Multifactorial binary logistic re-gression analysis,using the presence or absence of adverse events as the dependent variable(0=no adverse events,1=adverse events),revealed that NYHA classⅢ~Ⅳ,LVEF<45%,and elevated levels of serum hsTnI,Hcy,and BNP were independent risk factors affecting the occurrence of postoperative adverse events in patients with CVR(P<0.05).Conclusion Serum hsTnI,Hcy and BNP tests play a crucial role in the post-operative prognosis of patients undergoing CVR.Elevated levels of these biomarkers may indicate a higher risk of adverse events.Therefore,it is important to enhance monitoring and assessment of serum levels of hsTnI,Hcy and BNP in the clinic.This will help in detecting potential risk factors promptly,ultimately improving the prognosis of CVR surgery.