血清cTnT、NT-proBNP峰值评估急性心肌梗死后梗死面积及1年不良预后的临床价值

Clinical value of serum cTnT and NT-proBNP peaks in evaluating infarct size and one-year adverse prognosis after acute myocardial infarction

目的探讨肌钙蛋白T(cTnT)峰值联合氨基末端B型利钠肽前体(NT-proBNP)峰值评估急性心肌梗死(AMI)后梗死面积(IS)及1年不良事件的临床价值。方法回顾性分析2016年1月至2021年7月于上海市静安区中心医院就诊的AMI患者150例。每日检测cTnT及NT-proBNP至峰值出现,心脏磁共振评估IS,随访1年不良事件。logistic回归分析IS及不良事件发生的风险因素,ROC曲线分析cTnT、NTproBNP峰值的预后价值。结果共纳入49例患者,根据不良事件发生分为事件组(n=19)和无事件组(n=30),根据中位IS值分为IS≥18.26%组(n=25)和<18.26%组(n=24)。事件组IS、cTnT、NT-proBNP明显高于无事件组,差异有统计学意义(P<0.05)。IS≥18.26%组cTnT、NT-proBNP显著高于IS<18.26%组,不良事件发生有统计学意义(P<0.05)。ROC曲线显示cTnT峰值联合NT-proBNP峰值预测AMI预后效果最好,AUC为0.935,两指标联合预测IS的AUC为0.883。结论血清cTnT、NT-proBNP峰值能反映AMI心肌IS大小,具预后价值,两者联合效果更优。

Objective To investigate the clinical value of cardiac troponin T(cTnT)peak combined with N-terminal B-type natriuretic peptide(NT-proBNP)peak in evaluating the infarct size(IS)and one-year adverse events after acute myocardial infarction(AMI).Methods A total of 150 patients with AMI admitted to Shanghai Jing’an District Central Hospital from January 2016 to July 2021 were retrospectively analyzed.CTnT and NTproBNP were detected daily until the peak appeared,IS was evaluated by cardiac magnetic resonance imaging,and adverse events were followed up for one year.Logistic regression was used to analyze the risk factors of IS and adverse events,and ROC curve was used to analyze the prognostic value of peak values of cTnT and NTproBNP.Results A total of 49 patients were included.They were divided into the event group(n=19)and the no event group(n=30)according to the occurrence of adverse events,and were also divided into the IS≥18.26%group(n=25)and the IS<18.26%group(n=24)according to the median IS value.The levels of IS,cTnT and NTproBNP in the event group were significantly higher than those in the non-event group(P<0.05).The cTnT and NT-proBNP in the IS≥18.26%group were significantly higher than those in the IS<18.26%group,and the occurrence of adverse events was also different(P<0.05).The ROC curve showed that the peak value of cTnT combined with the peak value of NT-proBNP has the best effect in predicting the prognosis of AMI,with the AUC of 0.935,and the AUC of the two indices in jointly predicting IS was 0.883.Conclusion The peak values of serum cTnT and NT-proBNP can reflect the value of myocardial IS in AMI,which has prognostic significant,and the combined effect of them is superior.