急性心肌梗死患者血清脑啡肽酶水平与心肌顿抑的相关性分析  

Correlation analysis of serum neprilysin level and myocardial stunning in patients with acute myocardial infarction

作　　者：黄丙华 邹永伟[1] 吴贤翔 Huang Binghua;Zou Yongwei;Wu Xianxiang(Department of Cardiovascular Medicine,the Second People'sHospital of Hainan Province Department of Cardiovascular Medicine,Hainan Second People's Hospital,Wuzhishan 572299,China)

机构地区：[1]海南省第二人民医院心血管内科,五指山572299

出　　处：《广西医科大学学报》2022年第12期2001-2006,共6页Journal of Guangxi Medical University

基　　金：海南省卫生计生行业科研项目(No.15A200047)。

摘　　要：目的:分析急性ST段抬高型心肌梗死(STEMI)患者血清脑啡肽酶(NEP)水平与心肌顿抑的相关性。方法:选取2019年6月至2021年1月在本院接受经皮冠状动脉介入治疗(PCI)的STEMI患者200例,按血清NEP水平分为低水平组(血清NEP<188.10 pg/mL,n=66)、中水平组(188.10~839.90 pg/mL,n=68)和高水平组(>839.90 pg/mL,n=66)。分析3组患者的心功能指标变化。采用线性回归分析血清NEP水平与STEMI患者左室射血分数(LVEF)改善的关系。结果:高水平组患者T0时(PCI治疗后48 h内)高敏心肌肌钙蛋白I(hs-cTnI)水平高于低水平组、中水平组(P<0.05),LVEF和左心室舒张末期容积(EDV)低于低水平组(P<0.05)。在T1时(随访6个月后),高水平组、中水平组左心室收缩末期容积(ESV)高于低水平组(P<0.05)。经Spearman等级相关系数分析,STEMI患者血清NEP水平与hs-cTnI呈正相关关系(r=0.185,P<0.05),与T0时的LVEF、EDV呈负相关关系(r=-0.268、-0.390,P<0.001)。单变量和多变量线性回归分析显示,吸烟史、血清NEP水平与随访期间LVEF改善呈独立正相关(P<0.05)。结论:NEP与STEMI患者PCI术后的心功能改善程度相关,因此血清NEP水平可能预测STEMI患者PCI术后早期心肌顿抑的发生。Objective:To analyze the correlation between serum neprilysin(NEP)level and myocardial stunning in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:A total of 200 STEMI patients who received percutaneous coronary intervention(PCI)in Hainan Second People's Hospital from June 2019 to January 2021 were selected and divided into low level group(serum NEP<188.10 pg/mL,n=66)and medium level group(serum NEP<188.10-839.90 pg/mL),n=68)and high level group(>839.90 pg/mL,n=66)according to serum NEP level.The changes of cardiac function indexes in 3 groups were analyzed.Linear regression was used to analyze the relationship between serum NEP levels and the improvement of the left ventricular ejection fraction(LVEF)in STEMI patients.Results:The level of high-sensitivity cardiac troponin I(hs-cTnI)at T0(within 48 h after PCI)in high level group was higher than that in low and medium level groups(P<0.05),and the LVEF and left ventricle end-diastolic volume(EDV)were lower than that in low level group(P<0.05).At T1(6 months after follow-up),the left ventricle end-systolic volume(ESV)in the high and medium level groups was higher than that in the low level group(P<0.05).After Spearman correlation coefficient analysis,serum NEP level in STEMI patients was positively correlated with hs-cTnI(rs=0.185,P<0.05),and negatively correlated with LVEF and EDV at T0(rs=-0.268,-0.390,P<0.001).Univariate and multivariate linear regression analysis showed that smoking history and serum NEP level were positively and independently correlated with the improvement of LVEF during follow-up(P<0.05).Conclusion:NEP is associated with the improvement of cardiac function after PCI in STEMI patients.Therefore,serum NEP level may predict the occurrence of early myocardial stunning after PCI in STEMI patients.

关 键 词：急性ST段抬高型心肌梗死 脑啡肽酶 心肌顿抑 心功能 左室射血分数 

分 类 号：R542.22[医药卫生—心血管疾病]