NT-proBNP对急性心肌梗死患者新发房颤的预测价值研究  

NT-proBNP predicts new-onset atrial fibrillation following acute myocardial infarction

作　　者：扎西多杰[1] 王翔飞[1] 周京敏[1] 崔晓通[1] 张峰[1] 林佳雄[1] 王齐兵[1] 葛雷[1] 钱菊英[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,上海200032

出　　处：《中国分子心脏病学杂志》2013年第2期457-461,共5页Molecular Cardiology of China

摘　　要：目的探讨N末端B型脑利钠肽前体(NT-proBNP)对急性心肌梗死患者新发房颤的预测价值。方法从2008年1月至2010年12月收住我院心脏监护室的患者中入选急性心肌梗死(AMI)患者293例,按照患者住院期间是否出现房颤(AF)分为房颤组(n=43)和非房颤组(n=250)。比较两组间差异,分析血浆NT-proBNP水平对新发房颤的预测价值。结果 (1)AMI患者住院期间出现新发房颤的比例为14.7%;(2)房颤组患者NT-proBNP水平明显高于非房颤患者,且平均年龄较大,左心室射血分数、血红蛋白含量和肾小球滤过率(eGFR)均低于非房颤组;(3)多因素Logistic回归分析显示NT-proBNP可独立预测急性心肌梗死患者新发房颤(OR4.918,95%CI1.662-14.549,P=0.004)。结论血浆NT-proBNP水平可独立预测急性心肌梗死患者新发房颤的发生,可用于患者危险分层及指导早期预防治疗。Objective To investigate the predictive value of N terminal pro B type natriuretic peptide（NT-proBNP） for the occurrence of new- onset atrial fibrillation（AF） in patient with acute myocardial infarction（AMl）. Methods A total of 293 patients diagnosed with AMI between January 2008 to December 2010 in Zhongshan Hospital Fudan University were studied. The patients were divided into two groups by the presence or absence ofAF, NT-proBNP was measured within 24 hours after admission. Receiver operating characteristic analysis was performed to identify the most use- ful NT-proBNP cut-off level for the prediction of AF, the patients were divided into high NT-proBNP group（NT-proBNP 〉 613pg/mL, n=188） and low NT-proBNP group（NT-proBNP 〈613pg/mL, n-105） accordingly. Results （1） The incidence of new-onset AF in AMI patients was 14.7%, with no significant difference between ST-segment elevation myocardial infarction（STEMI） and non-ST elevation myocardial infarction（NSTEMl） patients ： （2） Patients with AF were older, had more often lower left ventricular ejection fraction, anemia and renal insufficiency ： （3） AF occurred more frequently in high NT-proBNP group（42/188, 22.3%） than in low NT-proBNP patients（1/105, 1%）, （P〈0.001） ; （4） Multivariate regression analysis showed that elevated plasma NT-proBNP levels was an strong predictor for new-onset AF after AMI（OR 4.918, 95% CI 1.662-14.549, P-0.004）. Conclusion Elevated plasma NT-proBNP levels independently predict new-onset AF in hospitalized AMI patients, NT-proBNP guided therapy may have a beneficial role in the prophylactic therapy that aimed to reduce the incidence of new-onset AF.

关 键 词：急性心肌梗死 房颤 冠状动脉介入治疗 NT-PROBNP 

分 类 号：R542.22[医药卫生—心血管疾病]