不同部位AMI患者發(fā)病48h內(nèi)血漿BNP水平變化及其對(duì)近期并發(fā)心力衰竭的預(yù)測(cè)價(jià)值
發(fā)布時(shí)間：2019-04-08 15:05
【摘要】：目的觀察不同部位急性心肌梗死(AMI)患者發(fā)病48 h內(nèi)血漿腦鈉肽(BNP)水平變化,并探討其對(duì)住院期間并發(fā)心力衰竭(HF)的預(yù)測(cè)價(jià)值。方法發(fā)病12 h內(nèi)行急診經(jīng)皮冠狀動(dòng)脈介入治療的AMI患者70例,按照心梗發(fā)生部位不同分為前壁組41例和非前壁組29例,比較術(shù)后1 h內(nèi)及發(fā)病12、20、24、48 h(分別計(jì)為T_1~T_5)血漿BNP;記錄患者住院期間HF發(fā)生情況,通過(guò)繪制受試者工作特征曲線(ROC曲線)確定各時(shí)點(diǎn)BNP對(duì)AMI患者住院期間并發(fā)HF的預(yù)測(cè)價(jià)值。結(jié)果與非前壁組比較,前壁組T_1~T_4時(shí)點(diǎn)血漿BNP水平升高;與同組T_1時(shí)點(diǎn)比較,兩組T_2~T_5時(shí)點(diǎn)血漿BNP水平升高;與同組T_2時(shí)點(diǎn)比較,兩組T_3、T_4時(shí)點(diǎn)血漿BNP水平升高;與同組T_3、T_4時(shí)點(diǎn)比較,兩組T_5時(shí)點(diǎn)血漿BNP水平降低;P均0.05。ROC曲線分析顯示,前壁組T_1~T_5時(shí)點(diǎn)BNP水平預(yù)測(cè)AMI住院期間并發(fā)HF的曲線下面積(AUC)分別為0.800、0.831、0.831、0.835、0.885,其中T_5時(shí)點(diǎn)AUC最大,此時(shí)BNP預(yù)測(cè)HF的最佳分界值為169.6 pg/mL,靈敏度和特異度分別為92.3%、70.0%;非前壁組在T_1~T_5時(shí)點(diǎn)BNP水平預(yù)測(cè)住院期間并發(fā)HF的AUC分別為0.653、0.801、0.847、0.784、0.761,其中T_3時(shí)點(diǎn)AUC最大,此時(shí)BNP預(yù)測(cè)HF的最佳分界值為178.5 pg/mL,靈敏度和特異度分別為100.0%、68.7%。結(jié)論前壁和非前壁AMI發(fā)病48 h內(nèi)BNP水平呈現(xiàn)先快速升高后緩慢下降的單峰趨勢(shì),達(dá)峰時(shí)間在發(fā)病20~24 h;不同部位AMI各時(shí)間點(diǎn)血漿BNP水平對(duì)AMI住院期間并發(fā)HF預(yù)測(cè)價(jià)值不同,發(fā)病48 h血漿BNP水平對(duì)前壁并發(fā)HF的預(yù)測(cè)價(jià)值最高,發(fā)病20 h血漿BNP水平對(duì)非前壁并發(fā)HF的預(yù)測(cè)價(jià)值最高。
[Abstract]:Aim to observe the changes of plasma levels of brain natriuretic peptide (BNP) in patients with acute myocardial infarction (AMI) within 48 hours after onset of acute myocardial infarction (AMI), and to evaluate the predictive value of brain natriuretic peptide (BNP) in patients with heart failure during hospitalization. Methods 70 AMI patients who underwent emergency percutaneous coronary intervention (PCI) within 12 hours of onset were divided into anterior group (n = 41) and non-anterior group (n = 29) according to the location of myocardial infarction. The plasma BNP; was compared within 1 hour after operation and 12, 20, 24, 48 hours after operation (T_1~T_5, respectively). The occurrence of HF during hospitalization was recorded, and the predictive value of BNP at each time point to HF in patients with AMI during hospitalization was determined by drawing the receiver operating characteristic curve (ROC curve). Results compared with the non-anterior group, the plasma BNP level in the anterior wall group was higher than that in the control group at the time of T_1~T_4, and the plasma BNP level at the time point of T_2~T_5 in the two groups was higher than that in the same group at 1 hour. Compared with the same group, the levels of plasma BNP in the two groups increased at 2 and 4 hours, and the plasma BNP levels in the two groups decreased at 5 hours as compared with those in the same group at 2 and 4 hours, and at the same time, the levels of plasma BNP in the two groups were significantly higher than those in the other two groups at 2 and 4 hours, respectively. P-all 0.05.ROC curve analysis showed that the BNP level at the time point of T_1~T_5 in the anterior wall group predicted the area (AUC) under the curve of AMI complicated with HF during hospitalization was 0.800, 0.831, 0.831, 0.835, 0.885, respectively. Among them, the AUC at 5 h was the largest. The optimal threshold for HF prediction by BNP was 169.6 pg/mL, sensitivity and specificity of 92.3% and 70.0%, respectively. The levels of BNP in the non-anterior wall group predicted the AUC of HF during hospitalization was 0.653, 0.801,0.847, 0.784, 0.761, respectively, and the AUC was the largest at the time of T_1~T_5. At this time, the optimal threshold value of BNP to predict HF was 178.5 pg/mL,. The sensitivity and specificity were 100. 0% and 68. 7%, respectively. Conclusion the level of BNP in the anterior wall and non-anterior wall of AMI showed a single peak trend in 48 hours after onset, and the peak time was at 20 hours after onset and then decreased slowly. The predictive value of plasma BNP level at different time points for AMI complicated with HF was different at different time points of AMI. Plasma BNP level at 48 h after onset had the highest predictive value for anterior wall complicated HF, and plasma BNP level at 20 h had the highest predictive value for non-anterior wall complicated with HF.
【作者單位】： 南方醫(yī)科大學(xué);廣州軍區(qū)廣州總醫(yī)院;南方醫(yī)科大學(xué)珠江醫(yī)院;
【基金】：廣東省信息產(chǎn)業(yè)發(fā)展專項(xiàng)基金(粵經(jīng)信[2014]975號(hào)) 廣州市科技計(jì)劃專項(xiàng)(2014Y2-00068);廣州市科技計(jì)劃產(chǎn)學(xué)研專項(xiàng)(201508020043) 廣州市重點(diǎn)實(shí)驗(yàn)室建設(shè)專項(xiàng)(穗科信字[2013]163-15號(hào))
【分類號(hào)】：R541.6;R542.22
[Abstract]:Aim to observe the changes of plasma levels of brain natriuretic peptide (BNP) in patients with acute myocardial infarction (AMI) within 48 hours after onset of acute myocardial infarction (AMI), and to evaluate the predictive value of brain natriuretic peptide (BNP) in patients with heart failure during hospitalization. Methods 70 AMI patients who underwent emergency percutaneous coronary intervention (PCI) within 12 hours of onset were divided into anterior group (n = 41) and non-anterior group (n = 29) according to the location of myocardial infarction. The plasma BNP; was compared within 1 hour after operation and 12, 20, 24, 48 hours after operation (T_1~T_5, respectively). The occurrence of HF during hospitalization was recorded, and the predictive value of BNP at each time point to HF in patients with AMI during hospitalization was determined by drawing the receiver operating characteristic curve (ROC curve). Results compared with the non-anterior group, the plasma BNP level in the anterior wall group was higher than that in the control group at the time of T_1~T_4, and the plasma BNP level at the time point of T_2~T_5 in the two groups was higher than that in the same group at 1 hour. Compared with the same group, the levels of plasma BNP in the two groups increased at 2 and 4 hours, and the plasma BNP levels in the two groups decreased at 5 hours as compared with those in the same group at 2 and 4 hours, and at the same time, the levels of plasma BNP in the two groups were significantly higher than those in the other two groups at 2 and 4 hours, respectively. P-all 0.05.ROC curve analysis showed that the BNP level at the time point of T_1~T_5 in the anterior wall group predicted the area (AUC) under the curve of AMI complicated with HF during hospitalization was 0.800, 0.831, 0.831, 0.835, 0.885, respectively. Among them, the AUC at 5 h was the largest. The optimal threshold for HF prediction by BNP was 169.6 pg/mL, sensitivity and specificity of 92.3% and 70.0%, respectively. The levels of BNP in the non-anterior wall group predicted the AUC of HF during hospitalization was 0.653, 0.801,0.847, 0.784, 0.761, respectively, and the AUC was the largest at the time of T_1~T_5. At this time, the optimal threshold value of BNP to predict HF was 178.5 pg/mL,. The sensitivity and specificity were 100. 0% and 68. 7%, respectively. Conclusion the level of BNP in the anterior wall and non-anterior wall of AMI showed a single peak trend in 48 hours after onset, and the peak time was at 20 hours after onset and then decreased slowly. The predictive value of plasma BNP level at different time points for AMI complicated with HF was different at different time points of AMI. Plasma BNP level at 48 h after onset had the highest predictive value for anterior wall complicated HF, and plasma BNP level at 20 h had the highest predictive value for non-anterior wall complicated with HF.
【作者單位】： 南方醫(yī)科大學(xué);廣州軍區(qū)廣州總醫(yī)院;南方醫(yī)科大學(xué)珠江醫(yī)院;
【基金】：廣東省信息產(chǎn)業(yè)發(fā)展專項(xiàng)基金(粵經(jīng)信[2014]975號(hào)) 廣州市科技計(jì)劃專項(xiàng)(2014Y2-00068);廣州市科技計(jì)劃產(chǎn)學(xué)研專項(xiàng)(201508020043) 廣州市重點(diǎn)實(shí)驗(yàn)室建設(shè)專項(xiàng)(穗科信字[2013]163-15號(hào))
【分類號(hào)】：R541.6;R542.22
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