血液Lp-PLA2、SAA、NT-proBNP对急性心肌梗死患者院内早期心衰的评估价值  

Value of Lp-PLA2,SAA,and NT-proBNP for predicting early heart failure of in-patients with AMI

作　　者：李令娟 刘冬 王卫娟 王宏伟 孙美娜 LI Lingjuan;LIU Dong;WANG Weijuan;WANG Hongwei;SUN Meina(Department of Cardiovascular Medicine,Fourth People's Hospital of Langfang City&Affiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China;Departments of Intervention,Fourth People's Hospital of Langfang&Affiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China)

机构地区：[1]廊坊市第四人民医院&承德医学院附属医院心血管内科,河北廊坊065700 [2]廊坊市第四人民医院&承德医学院附属医院介入科,河北廊坊065700

出　　处：《贵州医科大学学报》2023年第9期1066-1072,共7页Journal of Guizhou Medical University

基　　金：廊坊市科学技术研究与发展计划项目(2020013102)。

摘　　要：目的探讨血液脂蛋白相关磷脂酶A2(Lp-PLA2)、血清淀粉样蛋白A(SAA)、氨基末端脑钠肽前体(NT-proBNP)对急性心肌梗死(AMI)患者院内早期心衰的评估价值。方法选择254例AMI患者,根据入院后24 h内是否发生心衰分为心肌梗死(MI)组(n=136)和心肌梗死合并心力衰竭(MIHF)组(n=118),MIHF组根据Killip临床分级分为Ⅱ级(48例)、Ⅲ级(61例)和Ⅳ级(9例),选取同期急诊科冠脉造影正常者100例作为对照组;比较MI、MIHF及对照组血液Lp-PLA2、SAA、NT-proBNP等指标及心功能超声检查指标,比较各Killip临床分级患者血液Lp-PLA2、SAA及NT-proBNP水平;采用Pearson相关性分析探讨Lp-PLA2、SAA、NT-proBNP与冠状动脉Gensini积分、心衰Killip分级、左心功能超声指标的相关性,采用逐步回归法分析院内心衰的独立危险因素,采用ROC曲线分析Lp-PLA2、SAA及NT-proBNP单独和联合检测对AMI患者院内心衰的预测价值。结果MI组、MIHF组及对照组在年龄、Gensini积分、Lp-PLA2、SAA、NT-proBNP及LVEF、LVSV、LVEDV、LVESV、E/A、DT、Tei指数等指标比较差异有统计学意义(P<0.05);不同Killip分级AMI合并心衰患者Lp-PLA2、SAA及NT-proBNP水平比较,差异有统计学意义(P<0.05);Lp-PLA2、SAA、NT-proBNP与Gensini积分、Killip分级、LVSV、LVEDV、LVESV、DT、Tei指数呈正相关,与LVEF、E/A呈负相关(P<0.05);年龄、Gensini积分、Lp-PLA2、SAA及NT-proBNP是AMI患者院内心衰的独立危险因素(P<0.05);ROC曲线显示,Lp-PLA2、SAA及NT-proBNP联合检测预测AMI患者院内心衰的AUC为0.835,大于各指标单独预测的AUC(Z=2.197、2.260、2.398,P=0.041、0.037、0.029)。结论血液Lp-PLA2、SAA及NT-proBNP水平与AMI患者院内早期心衰有关,均对心衰发生有一定预测价值,三者联合检测可提升预测价值。Objective To investigate the value of Lp-PLA2,SAA,and NT-proBNP for predicting early heart failure of in-patients with acute myocardial infarction(AMI).Methods A total of 254 patients with AMI were divided into myocardial infarction(MI)group(n=136)and myocardial infarction with heart failure(MIHF)group(n=118)according to the occurrence of heart failure in AMI patients within 24 h after admission.According to Killip classification,MIHF group was divided into gradeⅡ(48 cases),gradeⅢ(61 cases),and gradeⅣ(9 cases).Patients with normal coronary angiography in the emergency department of our hospital during the same period were selected as the control group(n=100).The differences of LP-PLA2,SAA,NT-probNP,and related cardiac function ultrasound indicators were compared among different groups,the differences of Lp-PLA2,SAA,NT-proBNP were compared among different MIHF group,and the correlation between Lp-PLA2,SAA,NT-proBNP,and Gensini score,Killip grading,left heart function ultrasound indicators were explored by Pearson correlation analysis.Stepwise regression analysis was used to detect the influencing factors,and ROC curve was used to analyze the predictive value of Lp-PLA2,SAA,NT-proBNP alone and together.Results The differences were statistically different in age,Gensini scores,Lp-PLA2,SAA,NT-proBNP,LVEF,LVSV,LVEDV,LVESV,E/A,DT,and Tei index in MI group,MIHF group and the control group(P<0.05).There were statistically differences in Lp-PLA2,SAA,and NT-proBNP levels in AMI patients with early heart failure of different Killip grades(P<0.05).Lp-PLA2,SAA,NT-proBNP were positively correlated with Gensini integral,Killip grading,LVSV,LVEDV,LVESV,DT,and Tei index,and negatively correlated with LVEF,E/A(P<0.05).Age,Gensini scores,Lp-PLA2,SAA,and NT-proBNP were independent risk factors of nosocomial heart failure in AMI patients(P<0.05).ROC curve showed that the AUC of Lp-PLA2,SAA,and NT-proBNP combined to predict early heart failure of in-patients with AMI was 0.835,which was greater than that of each index alone(Z=2.

关 键 词：心肌梗死 脂蛋白相关性磷脂酶A2 血清淀粉样蛋白A 氨基末端脑钠肽前体 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]