N端脑钠肽前体预测首次急性心肌梗死后新发心房颤动的价值研究  

Predictive value of NT-proBNP for new-onset atrial fibrillation following acute myocardial infarction

作　　者：罗晓颖[1] 许燕[1] 张建盛[1] 吴立群[1] 戚文航[1] LUO Xiaoying;XU Yan;ZHANG Jiansheng;WU Liqun;QI Wenhang(Department of Cardiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,上海200025

出　　处：《诊断学理论与实践》2020年第3期303-307,共5页Journal of Diagnostics Concepts & Practice

基　　金：国家自然科学基金青年项目(81500196)。

摘　　要：目的:探讨首次急性心肌梗死患者入院时的血浆N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平与其新发心房颤动(房颤)间的关系。方法:测定236例首次急性心肌梗死(心梗)入院患者入院时以及急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后1 d、3 d、7 d的血浆NT-proBNP水平,并持续监测患者入院7 d内有无房颤发作,根据结果将患者分为房颤组(n=51)和无房颤组(n=185)。分析患者的临床资料、心脏超声和冠状动脉造影资料,应用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析NT-proBNP预测急性心梗患者新发房颤的临界值,采用多因素Cox回归分析评价NT-proBNP水平对急性心梗后新发房颤的预测价值。结果:急性心梗后的新发房颤率为21.6%。单因素分析发现,房颤组患者的年龄、左心房内径、C反应蛋白(C reactive protein,CRP)水平以及合并高血压、前壁心梗、左前降支和三支血管病变的构成比均显著高于无房颤组;房颤组患者的左心室射血分数显著低于无房颤组;房颤组患者的NT-proBNP水平无论在入院时,还是术后1 d、3 d和7 d均显著高于无房颤组(P<0.05)。ROC曲线显示,入院时NT-proBNP水平预测急性心梗患者新发房颤的曲线下面积为0.74(95%CI为0.60~0.90,P<0.01),最佳临界值为1403.6 ng/L。多因素Cox回归分析显示,NT-proBNP>1403.6 ng/L(OR=1.8,95%CI为1.3~2.4)、年龄>69岁(OR=1.6,95%CI为1.3~3.1)和左心房内径>43.8 mm(OR=1.3,95%CI为1.1~1.9)是首次心梗患者新发房颤的独立预测因素(P<0.05)。结论:血浆NT-proBNP水平检测在早期预测急性心梗后新发房颤中有一定的临床价值。Objective:To investigate relationship between N-terminal pro-brain natriuretic peptide(NT-proBNP)level and new-onset atrial fibrillation(AF)in patients with acute myocardial infarction(AMI).Methods:A total of 236 AMI patients admitted within 24 hours of onset were tested for NT-proBNP level upon admission,and 1 day,3 days,and 7 days after primary percutaneous coronary intervention(PCI).All patients were monitored continuously for new-onset AF for 7 days,and were later divided into AF group(n=51)and non-AF group(n=185).Clinical manifestations,echocardiographic and angiographic data were also reviewed in all patients.The impact of NT-proBNP level on new-onset AF following initial AMI was analyzed with multi-factor Cox regression analysis.The receiver operator characteristic curve(ROC curve)was used to determine the predictive cutoff value of NT-proBNP for the occurrence of new-onset atrial fibrillation following initial AMI.Results:AF occurred in 21.6%of patients.The univariate analysis showed that patients with new-onset AF had an older age,larger left atrial diameter(LAD),higher C reactive protein(CRP)level,higher percentage of the population with high blood pressure,anterior AMI,left-anterior-descending-artery lesion and 3-vessel lesion,and lower left ventricular ejection fraction(P<0.05).Levels of NT-proBNP were higher in patients with AF than those in patients without at any point of test(P<0.05).Area under ROC(AUC)of NT-proBNP to predict new-onset AF was 0.74(95%CI 0.60-0.90,P<0.01),with an optimal cut-off value of 1403.6 pg/mL.Multivariate analysis showed that NT-proBNP level(>1403.6 pg/mL)(OR=1.8,95%CI 1.3-2.4),age(>69 years old)(OR=1.6,95%CI 1.3-3.1)and LAD(>43.8 mm)(OR=1.3,95%CI为1.1-1.9)were independent predictors of occurrence of new-onset AF.Conclusion:Serum NT-proBNP level is of certain value in early prediction of the new-onset AF following AMI.

关 键 词：N端脑钠肽前体 急性心肌梗死 新发心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病]