不同部位AMI患者发病48h内血浆BNP水平变化及其对近期并发心力衰竭的预测价值  

Dynamic changes of plasma BNP levels within 48 h in patients with acute myocardial infarction at different sites and their predictive value for recent concurrent heart failure

作　　者：李慧娣 向定成[1,2] 张金霞[2] 肖华[3] 易绍东[2] 李爱敏[2] 龙锋[2] LI Huidi XIANG Dingcheng ZHANG Jingxia XIAO Hua YI Shaodong LI Aimin LONG Feng(Southern Medical University, Guangzhou 510515, China)

机构地区：[1]南方医科大学,广州510515 [2]广州军区广州总医院 [3]南方医科大学珠江医院

出　　处：《山东医药》2017年第31期17-20,共4页Shandong Medical Journal

基　　金：广东省信息产业发展专项基金(粤经信[2014]975号);广州市科技计划专项(2014Y2-00068);广州市科技计划产学研专项(201508020043);广州市重点实验室建设专项(穗科信字[2013]163-15号)

摘　　要：目的观察不同部位急性心肌梗死(AMI)患者发病48 h内血浆脑钠肽(BNP)水平变化,并探讨其对住院期间并发心力衰竭(HF)的预测价值。方法发病12 h内行急诊经皮冠状动脉介入治疗的AMI患者70例,按照心梗发生部位不同分为前壁组41例和非前壁组29例,比较术后1 h内及发病12、20、24、48 h(分别计为T_1~T_5)血浆BNP;记录患者住院期间HF发生情况,通过绘制受试者工作特征曲线(ROC曲线)确定各时点BNP对AMI患者住院期间并发HF的预测价值。结果与非前壁组比较,前壁组T_1~T_4时点血浆BNP水平升高;与同组T_1时点比较,两组T_2~T_5时点血浆BNP水平升高;与同组T_2时点比较,两组T_3、T_4时点血浆BNP水平升高;与同组T_3、T_4时点比较,两组T_5时点血浆BNP水平降低;P均<0.05。ROC曲线分析显示,前壁组T_1~T_5时点BNP水平预测AMI住院期间并发HF的曲线下面积(AUC)分别为0.800、0.831、0.831、0.835、0.885,其中T_5时点AUC最大,此时BNP预测HF的最佳分界值为169.6 pg/mL,灵敏度和特异度分别为92.3%、70.0%;非前壁组在T_1~T_5时点BNP水平预测住院期间并发HF的AUC分别为0.653、0.801、0.847、0.784、0.761,其中T_3时点AUC最大,此时BNP预测HF的最佳分界值为178.5 pg/mL,灵敏度和特异度分别为100.0%、68.7%。结论前壁和非前壁AMI发病48 h内BNP水平呈现先快速升高后缓慢下降的单峰趋势,达峰时间在发病20~24 h;不同部位AMI各时间点血浆BNP水平对AMI住院期间并发HF预测价值不同,发病48 h血浆BNP水平对前壁并发HF的预测价值最高,发病20 h血浆BNP水平对非前壁并发HF的预测价值最高。Objective To observe the dynamic changes of plasma brain natriuretic peptide（BNP） levels within 48 h from the onset of acute myocardial infarction（AMI） at different sites in patients and to explore their predictive values for recent concurrent heart failure（HF）.Methods According to the infarction sites,70 patients with AMI who underwent emergency percutaneous coronary intervention（PCI） within 12 hours from AMI onset were divided into the anterior wall group（n=41） and non-anterior wall group（n=29）.And the levels of plasma BNP were compared within 1 h after PCI and at 12,20,24,and 48 h after AMI onset（T1-T5,respectively）.The incidence of HF during hospitalization was recorded.The predictive value of BNP at each time point for the recent concurrent HF was determined by using the receiver operating characteristic（ROC） curve.Results Compared with the non-anterior wall group,the level of plasma BNP was higher than that in the anterior wall group at T1-T4.The levels of plasma BNP at T2-T5 in each of the two groups increased as compared with that at T1.The levels of plasma BNP at T3 and T4in each of the two groups increased as compared with that at T2.The levels of plasma BNP at T5 in each of the two groups decreased as compared with that at T3 and T4（all P〈0.05）.ROC curve analysis showed that,in the anterior wall group,the areas under the curve（AUC） of the BNP levels in predicting AMI complicated with HF during hospitalization at T1-T5 were 0.800,0.831,0.831,0.835,and 0.885,respectively.The maximum AUC was at T5,its best cutoff value of BNP was 169.6 pg/mL,and its sensitivity and specificity were 92.3% and 70.0%,respectively.In non-anterior wall group,the AUC of the BNP levels in predicting AMI complicated with HF during hospitalization at T1-T5 were 0.653,0.801,0.847,0.784,and 0.761,respectively.The maximum AUC was at T3,its best cutoff value of BNP was 178.5 pg/mL,and its sensitivity and specificity were 100.0% and 68.7%,respectively.Conclusions Within 48 h after AMI onset,BNP

关 键 词：急性心肌梗死 脑钠肽 心力衰竭 

分 类 号：R541.4[医药卫生—心血管疾病]