多种指标对不同BMI分层下急性心肌梗死患者左心室收缩功能障碍的预测价值研究

Study on predictive value of multiple indicators for left ventricular systolic dysfunction in patients with acute myocardial infarction under different body mass indexes stratification

目的研究心率(HR)、C反应蛋白(CRP)、氨基端前脑钠素(NT-proBNP)、肌红蛋白(MYO)等临床指标对不同BMI分层下经皮冠状动脉介入治疗(PCI)术后急性心肌梗死(AMI)患者左心室收缩功能障碍(LVSD)的预测价值。方法选取兰州大学第一医院2020年1-12月收治的353例AMI患者作为研究对象。采用Simpson法检测LVEF,将LVEF<0.5的研究对象纳入LVSD组,LVEF≥0.5的研究对象纳入对照组。依照BMI把AMI患者分为瘦型/正常型(BMI<24 kg/m^(2))与超重/肥胖型(BMI≥24 kg/m^(2))。收集患者一般资料、实验室指标和心肌酶指标,对不同BMI分层的不同组患者进行比较。采用受试者工作特征(ROC)曲线和曲线下面积(AUC)分析不同指标的预测效能。结果瘦型/正常型AMI患者153例,其中LVSD组54例,对照组99例;超重/肥胖型AMI患者200例,其中LVSD组60例,对照组140例。在瘦型/正常型AMI患者中,LVSD组HR、CRP、NT-proBNP、MYO、cTnI水平均高于对照组,差异有统计学意义(P<0.05);在超重/肥胖型AMI患者中,LVSD组HR、CRP、NEUT、PLT、NT-proBNP水平均高于对照组,年龄低于对照组,差异有统计学意义(P<0.05)。瘦型/正常型AMI患者中,HR为单指标预测效果最好的因子,AUC为0.701(95%CI:0.612~0.790);HR+MYO+CRP为联合预测瘦型/正常型AMI患者LVSD效果最好的因子组合,AUC为0.769(95%CI:0.690~0.849)超重/肥胖型AMI患者中,NT-proBNP为单指标预测效果最好的因子,AUC为0.706(95%CI:0.613~0.786);NT-proBNP+CRP是联合预测超重/肥胖型AMI患者LVSD效果最好的因子组合,AUC为0.761(95%CI:0.687~0.833)。结论不同BMI分层AMI患者中,联合预测比单指标预测的预测效果更好,HR+MYO+CRP对瘦型/正常型AMI患者LVSD具有更好的预测效果,而NT-proBNP+CRP对超重/肥胖型AMI患者LVSD具有更好的预测效果。

Objective To investigate the predictive value of heart rate(HR),C-reactive protein(CRP),amino-probrain natriuretic hormone(NT-proBNP),myoglobin(MYO)and other clinical indicators for left ventricular systolic dysfunction(LVSD)in the patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)under different body mass index(BMI)stratification.Methods A total of 353 patients with AMI admitted and treated in the First Hospital of Lanzhou University from January 2020 to December 2020 were selected as the study subjects.The Simpson method was adopted to detect the left ventricular ejection fraction(LVEF).The study subjects with LVEF<0.05 were included in the LVSD group,while those with LVEF≥0.5 were included in the control group.The AMI patients were divided into the lean/normal type(BMI<24 kg/m^(2))and overweight/obese type(BMI≥24 kg/m^(2))according to BMI.The general data of the patients,laboratory indexes and myocardial enzyme indicators were collected.The different groups with different BMI stratifications conducted the comparison.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were adopted to analyze the predictive efficiency of different indicators.Results There were 153 cases of lean/normal type AMI,in which there were 54 cases in the LVSD group and 99 cases in the control group.Among 200 cases of overweight/obese type AMI,60 cases were in the LVSD group and 140 cases were in the control group.In the patients with lean/normal AMI,HR,CRP,NT-proBNP,MYO and cTnl levels in the LVSD group were higher than those in the control group,and the differences were statistically significant(P<0.05).In the patients with overweight/obese type AMI,HR,CRP,NEUT,PLT and NT-proBNP levels in the LVSD group were higher than those in the control group,the age was lower than that in the control group,and the differences were statistically significant(P<0.05).In the patients with the lean/normal type AMI,HR was the best factor for single index prediction effect,AUC was 0.701(95%CI:0.612-0.790).HR+MYO+CRP was the best factors combination of combination prediction for LVSD in the patients with lean/normal type AMI.AUC was 0.769(95%CI:0.690-0.849).In the patients with overweight/obese AMI,NT-proBNP was the best factor for the best effect of single indicator prediction,AUC was 0.706(95%CI:0.613-0.786);NT-proBNP+CRP was the best factor combination in the combination for predicting LVSD in the patients with overweight/obese type AMI,AUC was 0.761(95%CI:0.687-0.833).Conclusion In the patients with different BMI stratifications of AMI,the combination prediction has a better predictive effect than the single indicator.HR+MYO+CRP has the better predictive effect for LVSD in the patients with lean/normal type AMI,while NT-proBNP-+CRP has better predictive effect for LVSD in the patients with overweight/obese type AMI.