自主神经张力血清D-二聚体及醛固酮在急性心肌梗死患者发生心血管不良事件中的检测价值  

Analysis of the detection value of serum D-D,autonomic nervous tension and aldosterone in MACE of the patients with AMI

作　　者：郝迎军[1] 周姝[2] 李丽君 Hao Ying-jun;Zhou Shu;Li Li-jun(Laboratory Department,Xinxiang Central Hospital,Xingxiang 453000,China)

机构地区：[1]新乡市中心医院检验科,河南新乡453000 [2]新乡市中心医院心血管内科,河南新乡453000 [3]新乡市中心医院核医学科,河南新乡453000

出　　处：《中国急救医学》2020年第4期324-328,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 探究自主神经张力[心率减速力(DC)和心率变异性(HRV)]、血清D-二聚体(D-D)及醛固酮(ALD)与急性心肌梗死(AMI)患者心血管不良事件(MACE)的相关性及其对AMI患者MACE检测的临床价值.方法 选取2017年1月至2019年1月新乡市中心医院收治的150例AMI患者,依照患者是否发生MACE分为MACE组(研究组,n=57)和未发生MACE组(对照组,n =93),统计对比两组患者临床一般资料、DC、HRV及血清D-D、ALD水平.分析患者一般资料、DC、HRV及血清D-D、ALD水平与MACE发生的相关性.结果 研究组与对照组年龄(岁:60.5 ±4.8 vs.59.2±4.4)、性别、体质量指数(BMI)(kg/m2:23.2±2.9 vs.23.9±3.1)、糖尿病史、吸烟史、高血压史、总胆固醇(mmol/L:4.5±1.2 vs.4.3±1.1)、血红蛋白(g/L:131.4±18.8 vs.135.3±20.2)、血小板计数(×109/L:207.8 ±39.1 vs.203.5 ±36.6)比较差异无统计学意义(P>0.05);研究组与对照组收缩压(mmHg:107.7±10.5 vs.119.6 ±11.3)、舒张压(mm Hg:63.2±6.0 vs.73.1±6.5)、心率(次/min:78.2±5.3 vs.72.1±5.8)、NT-proBNP(ng/mL:1203.2 ±234.6 vs.817.7 ±105.5)、DC(ms:2.9±1.1 vs.3.6±1.6)、SDNN(ms:75.8±11.5 vs.110.5 ±14.0)及血清D-D(μg/L:220.9±13.9 vs.187.3 ±14.5)、ALD(pmol/L:160.7±15.2 vs.130.5±13.0)水平比较差异有统计学意义(P<0.05).单因素回归分析显示,收缩压、舒张压、心率、NT-proBNP、DC、SDNN及血清D-D、ALD是AMI患者MACE发生的危险因素(x2=7.125,8.933,7.450,10.277,9.602,9.311,11.275,10.400;P< 0.05).Logstic多因素回归分析显示,NT-proBNP、DC、SDNN及血清D-D、ALD是AMI患者MACE发生的独立危险因素(P<0.05).Pearson相关性分析结果显示,DC与D-D、NT-proBNP、ALD呈显著负相关(r=-0.788,-0.592,-0.615;P<0.05);SDNN与D-D、NT-proBNP、ALD呈显著负相关(r=-0.753,-0.610,-0.646;P<0.05).结论 自主神经张力、D-D、NT-proBNP及ALD与AMI患者发生MACE存在显著相关性,是AMI患者发生MACE的重要危险因素,对AMI患者MACE诊断有一定价值.Objective To explore the correlation of autonomic nervous tension[heart rate deceleration(DC),heart rate variability(HRV)],serum D-dimer(D-D),aldosterone(ALD)with major adverse cardiac events(MACE)in the patients with acute myocardial infarction(AMI),and their clinical value in MACE testing of the patients with AMI.Methods A total of 150 patients with AMI admitted to our hospital from January 2017 to January 2019 were enrolled.According to whether the patients had MACE or not,they were divided into MACE group(study group,n=57)and no MACE group(control group,n=93).The patient^general data,DC,HRV and serum D-D,ALD levels in the two groups of patients were compared and their relationship with MACE were analyzed.Results There were no significant differences in age,gender,body mass index(BMI),history of diabetes,history of smoking,history of hypertension,total cholesterol,hemoglobin,and platelet count between the study group and the control group(P>0.05).The systolic blood pressure[(107.7±10.5)mmHg vs.(119.6±11.3)mmHg],diastolic blood pressure[(63.2±6.0)mmHg vs.(73.1±6.5)mmHg],heart rate[(78.2±5.3)beats/min vs.(72.1±5.8)beats/min],N-terminal pronatriuretic peptide(NT-proBNP)[(1203.2±234.6)ng/mL vs.(817.7±105.5)ng/mL,DC[(2.9土1.1)ms vs.(3.6土1.6)ms],SDNN[(75.8±11.5)ms vs.(110.5±14.0)ms]and serum D-D[(220.9士13.9)μg/L vs.(187.3±14.5)μg/L],and ALD[(160.7±15.2)pmol/L vs.(130.5±13.0)pmol/L]levels were statistically significant(P<0.05).Univariate regression analysis showed that systolic blood pressure,diastolic blood pressure,heart rate,NT-proBNP,DC,SDNN and serum D-D,ALD levels were risk factors for MACE in AMI patients(X^2=7.125,8.933,7.450,10.277,9.602,9.311,11.275,10.400,P<0.05).Logistic multivariate regression analysis showed that NT-proBNP,DC,SDNN and serum D-D,ALD levels were independent risk factors for MACE in the patients with AMI(P<0.05).Pearson correlation analysis showed that there was a significant negative correlation between DC and D-D,NT-proBNP and ALD(r=-0.788,-0.592,-0.615,P<0.05).There

关 键 词：自主神经张力 血清D-二聚体 醛固酮 急性心肌梗死 心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]