血清PCT、D-二聚体及BNP在急性心肌梗死患者PCI后心功能及预后的应用价值  

Application value of serum procalcitonin,D-dimer and B-type natriuretic peptide in heart function and prognosis in patients with acute myocardial infarction after PCI

作　　者：朱秀英[1] 吴畏[1] 李广鹏[1] 梁万前 Zhu Xiuying;Wu Wei;Li Guangpeng;Liang Wanqian(Department of Emergency,First Affiliated Hospital of Xinxiang Medical College,Henan Province,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院急诊科,新乡453100

出　　处：《中国循证心血管医学杂志》2020年第4期455-459,463,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后血清降钙素原(PCT)、D-二聚体(D-D)、脑钠肽(BNP)水平与心功能的相关性以及对AMI患者预后的预测价值。方法回顾性研究。选择2015年12月~2017年12月期间于新乡医学院第一附属医院收治的220例行PCI治疗的AMI患者为研究对象,分析不同心功能Killip分级、不同预后患者血清PCT、D-D、BNP水平的差异。双变量相关性分析PCT、D-D、BNP与心功能的关系,Cox回归分析PCT、D-D、BNP对AMI患者预后的影响,受试者工作特征曲线(ROC)分析PCT、D-D、BNP对AMI预后的预测价值,Kaplan-Meier生存分析不同PCT、D-D、BNP水平下AMI患者生存率。结果PCT、D-D、BNP、C反应蛋白(CRP)、肌钙蛋白I(cTnI)水平随着心功能降低而增加(P<0.05),左室射血分数(LVEF)随着心功能降低而降低(P<0.05)。PCT、D-D、BNP与LVEF呈负相关(r=-0.315、-0.401、-0.352,P<0.05),与Killip分级呈正相关(r=0.432、0.395、0.382,P<0.05)。死亡组患者血清PCT、D-D、BNP、cTnI、CRP水平明显高于存活组患者(P<0.05),LVEF低于存活组(P<0.05)。Cox回归分析PCT(RR=2.281,P=0.000)、D-D(RR=3.604,P=0.002)、BNP(RR=2.793,P=0.005)是影响AMI患者预后的独立危险因素。ROC分析血清PCT、D-D、BNP预测AMI患者预后曲线下面积分别为:0.833(95%CI:0.730~0.936,P=0.000)、0.822(95%CI:0.709~0.935,P=0.000)、0.865(95%CI:0.760~0.970,P=0.000)。当PCT>1.13μg/L、D-D>2510.61 pg/ml、BNP>1048.50 pg/ml时,AMI患者30 d生存率明显下降。结论血清PCT、D-D、BNP水平可反映AMI患者PCI术后心功能状态,是预测AMI患者预后的有效血清学指标。Objective To discuss the correlation among levels of serum procalcitonin(PCT),D-dimer(D-D),B-type natriuretic peptide(BNP)and heart function,and predictive value of them to prognosis in patients with acute myocardial infarction(AMI)after PCI.Methods AMI patients undergone PCI(n=220)were chosen from the First Affiliated Hospital of Xinxiang Medical College from Dec.2015 to Dec.2017.The difference in Killip grading and levels of PCT,D-D and BNP were analyzed in patients with difference prognosis.The relationship among PCT,D-D,BNP and heart function was analyzed by using bivariate correlation analysis,and influence of PCT,D-D and BNP on prognosis was analyzed by using Cox regression analysis in AMI patients.The predictive value of PCT,D-D and BNP to AMI was analyzed by using receiver operating characteristic(ROC)curve,and survival rate was analyzed by using Kaplan-Meier survival analysis in AMI patients with different levels of PCT,D-D and BNP.Results The levels of PCT,D-D,BNP,C-reactive protein(CRP)and cardiac troponin I(cTnI)increased along with heart function decrease(P<0.05),and left ventricular ejection fraction(LVEF)decreased along with heart function decrease(P<0.05).The levels of PCT,D-D and BNP were negatively correlated to LVEF(r=-0.315,r=-0.401,r=-0.352,P<0.05),and positively correlated to Killip grading(r=0.432,r=0.395,r=0.382,P<0.05).The levels of PCT,D-D,BNP,cTnI and CRP were significantly higher(P<0.05)and LVEF was lower(P<0.05)in death group than those in survival group.The results of Cox regression analysis showed that PCT(RR=2.281,P=0.000),D-D(RR=3.604,P=0.002)and BNP(RR=2.793,P=0.005)were independent risk factor influencing prognosis in AMI patients.ROC analysis showed that the area under curve(AUC)of PCT was 0.833(95%CI:0.730~0.936,P=0.000),AUC of D-D was 0.822(95%CI:0.709~0.935,P=0.000)and AUC of BNP was 0.865(95%CI:0.760~0.970,P=0.000)for predicting prognosis in AMI patients.When PCT>1.13μg/L,D-D>2510.61 pg/ml and BNP>1048.50 pg/ml,the survival rate of 30 d decreased significantly in AMI patie

关 键 词：降钙素原 D-二聚体 B型脑钠肽 急性心肌梗死 心功能 预后 

分 类 号：R542.22[医药卫生—心血管疾病]