24h心电图下心率变异性联合BNP、CK-MB对急性心肌梗死后MACE的预测价值  

Predictive value of heart rate variability combined with BNP and CK⁃MB on MACE after acute myocardial infarction under 24h electrocardiogram

作　　者：李朝晖[1] 杨梦婵 吕柯 LI Chaohui;YANG Mengchan;LV Ke(Electrocardiogram Room of Nanyang First People's Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第一人民医院心电图室,河南南阳473000

出　　处：《潍坊医学院学报》2023年第2期147-150,共4页Acta Academiae Medicinae Weifang

摘　　要：目的 探讨24h心电图下心率变异性(HRV)联合脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)对急性心肌梗死(AMI)后主要不良心血管事件(MACE)的预测价值。方法 选取2019年5月~2021年12月本院收治的108例AMI患者为研究对象,经皮冠状动脉介入术(PCI)治疗结束后随访1个月,依据随访期间是否发生MACE分为发生组29例和未发生组79例。分析入院时、术后7d两组24h心电图下心率变异性(HRV)指标[24h内正常R-R间期标准差(SDNN)、0.04~0.15Hz低频成分(LF)、0.16~0.40Hz高频成分(HF)]、血清脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)水平。分析各指标(术后7 d)对AMI后MACE发生的预测价值,Logistic回归分析AMI后MACE发生的影响因素。结果 与入院时比较,术后7d两组HRV指标升高,BNP、CK-MB水平降低(P<0.05),且发生组改变幅度大于未发生组(P<0.05);联合预测AMI后MACE的AUC大于单项预测(P<0.05);HRV指标(SDNN、LF、HF)降低,BNP、CK-MB水平升高是AMI后MACE发生的危险因素(P<0.05)。结论 24h心电图下HRV联合BNP、CK-MB对AMI后MACE的预测价值较高,有助于临床医师更好识别MACE高危患者。Objective To investigate the predictive value of heart rate variability(HRV)combined with brain natriuretic peptide(BNP)and creatine kinase isoenzyme(CK⁃MB)on major adverse cardiovascular events(MACE)after acute myocardial infarction(AMI)under 24⁃hour electrocardiogram(24h⁃ECG).Methods From May 2019 to December 2021,108 patients with AMI admitted to our hospital were selected as the study objects.After the completion of percutaneous coronary intervention(PCI),they were followed up for one month.Ac⁃cording to whether MACE occurred during the follow⁃up period,they were divided into the occurrence group of 29 cases and the non⁃occur⁃rence group of 79 cases.The indexes of heart rate variability(HRV)[24⁃hour standard deviation of normal R⁃R interval(SDNN),0.04~0.15Hz low frequency component(LF),0.16~0.40Hz high frequency component(HF)],serum brain natriuretic peptide(BNP),creatine ki⁃nase isoenzyme(CK⁃MB),were analyzed at admission and seven days after operation.The predictive value of each index(seven days after op⁃eration)on the occurrence of MACE after AMI was analyzed,and the influencing factors of MACE after AMI were analyzed by logistic regres⁃sion.Results Compared with those at admission,HRV index increased seven days after operation in both groups,while BNP and CK⁃MB lev⁃els decreased seven days after operation in both groups.Area under ROC curve(AUC)of MACE after joint prediction of AMI was greater than that of single prediction(P<0.05);The decrease of HRV indexes(SDNN,LF,HF)and the increase of BNP and CK⁃MB levels were the risk factors for MACE after AMI(P<0.05).Conclusion HRV combined with BNP and CK⁃MB under 24h ECG has a high predictive value for MACE after AMI,which is helpful for clinicians to better identify high⁃risk patients with MACE.

关 键 词：心肌梗死 急性 主要不良心血管事件 心率变异性 脑钠肽 肌酸激酶同工酶 

分 类 号：R542.22[医药卫生—心血管疾病]