急性心肌梗死患者血清脑利钠肽、癌胚抗原125、白细胞介素-6水平变化及其临床意义  

Changes of serum brain natriuretic peptide,cancer antigen 125 and interleukin-6 levels in patients with acute myocardial infarction and their clinical significance

作　　者：黎丹 孙莉芳 秦蕊 LI Dan;SUN Lifang;QIN Rui(Hubei Shizhen Laboratory,Hubei Provincial Hospital of Traditional Chinese Medicine,the Affiliated Hospital of Hubei University of Traditional Chinese Medicine,Wuhan,Hubei,430000;Department of Critical Care Medicine,the People′s Hospital of Wuhan University,Wuhan,Hubei,430000)

机构地区：[1]湖北省中医院/湖北中医药大学附属医院湖北时珍实验室,湖北武汉430000 [2]武汉大学人民医院重症医学科,湖北武汉430000

出　　处：《实用临床医药杂志》2024年第22期71-77,共7页Journal of Clinical Medicine in Practice

基　　金：2021年湖北省科技计划项目(2021FFB6320)。

摘　　要：目的探讨血清脑利钠肽(BNP)、癌胚抗原125(CA125)、白细胞介素-6(IL-6)水平与急性心肌梗死(AMI)患者病情程度的相关性及其预测经皮冠状动脉介入(PCI)术后主要不良心血管事件(MACE)的价值。方法选取行PCI术的100例AMI患者为研究对象,根据是否发生MACE分为MACE组(n=36)和非MACE组(n=64)。比较2组临床资料以及血清BNP、CA125、IL-6水平。分析血清BNP、CA125、IL-6水平与AMI病情程度的相关性。分析AMI患者PCI术后发生MACE的影响因素。采用受试者工作特征(ROC)曲线评估血清BNP、CA125、IL-6预测PCI术后发生MACE的价值。将常规影响因素联合作为常规预测方案,将常规预测方案联合血清BNP、CA125、IL-6作为新预测方案,通过曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)比较2种预测方案预测PCI术后发生MACE的价值。结果100例AMI患者中,PCI术后3个月内发生MACE 36例。MACE组年龄、白细胞(WBC)计数、既往心梗史占比、病情严重程度高于非MACE组,差异有统计学意义(P<0.05)。MACE组血清BNP、CA125、IL-6水平高于非MACE组,差异有统计学意义(P<0.05)。MACE组血清BNP、CA125、IL-6水平与AMI病情程度呈正相关(r=0.513、0.406、0.320,P<0.05)。年龄、WBC、既往心肌梗死史、血清BNP、CA125、IL-6为PCI术后发生MACE的影响因素(P<0.05)。血清BNP、CA125、IL-6联合预测MACE发生的AUC大于各指标单独预测的AUC(Z=2.134、2.005、2.087,P<0.05)。将年龄、WBC、既往心肌梗死史联合作为常规预测方案,将常规预测方案联合血清BNP、CA125、IL-6作为新预测方案。新预测方案的AUC大于常规预测方案的AUC(Z=2.321,P<0.05);新预测方案与常规预测方案比较,NRI、IDI均>0(P<0.05)。结论PCI术后发生MACE的AMI患者的血清BNP、CA125、IL-6水平升高,且与AMI病情程度密切相关。血清BNP、CA125、IL-6水平对PCI术后发生MACE具有一定预测价值。构建的含血清BNP、CA125、IL-6的�Objective To investigate the correlation between serum levels of brain natriuretic peptide(BNP),cancer antigen 125(CA125)and interleukin-6(IL-6)with the severity of acute myocardial infarction(AMI)and to evaluate their predictive value for major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI).Methods A total of 100 AMI patients who underwent PCI were enrolled in this study.Patients were divided into MACE group(n=36)and non-MACE group(n=64)based on the occurrence of MACE.Clinical data and serum levels of BNP,CA125 and IL-6 were compared between the two groups.The correlations of serum BNP,CA125 and IL-6 levels with the severity of AMI were analyzed.Factors influencing the occurrence of MACE after PCI in AMI patients were examined.Receiver operating characteristic(ROC)curves were used to assess the predictive value of serum BNP,CA125 and IL-6 for MACE after PCI.Conventional predictive scheme combined risk factors served as the conventional prediction model,while a new prediction model was developed by incorporating serum BNP,CA125 and IL-6 into the conventional model.The area under the curve(AUC),net reclassification improvement(NRI)and integrated discrimination improvement(IDI)were used to compare the predictive values of the two models.Results Among the 100 AMI patients,36 experienced MACE within three months after PCI.The MACE group had significantly higher age,white blood cell(WBC)count,prevalence of prior myocardial infarction and severity of AMI compared to the non-MACE group(P<0.05).Serum levels of BNP,CA125 and IL-6 were significantly higher in the MACE group than in the non-MACE group(P<0.05).Serum BNP,CA125 and IL-6 levels were positively correlated with the severity of AMI(r=0.513,0.406,0.320;P<0.05).Age,WBC count,history of myocardial infarction,and serum BNP,CA125 as well as IL-6 were identified as significant predictors for MACE after PCI(P<0.05).The AUC for the combined prediction for MACE using BNP,CA125 and IL-6 was greater than that of each individual marker(Z=2.13

关 键 词：急性心肌梗死 脑利钠肽 癌胚抗原125 白细胞介素-6 经皮冠状动脉介入 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病] R446.11[医药卫生—内科学] R392.1[医药卫生—临床医学]