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急性非ST段抬高型心肌梗死患者PCI术后NT-proBNP水平<br />对其生存的预测价值

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摘要:

目的 分析急性非ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)
术后血浆N末端脑钠肽前体(NT-proBNP)水平对其生存的预测价值,为临床提供参考依据,以提高
患者生存率。方法 将2019年9月至2021年3月于首都医科大学宣武医院急诊科首诊的120例急性非ST段
抬高型心肌梗死患者纳为研究对象,患者均行PCI后,根据不同手术时机分为择期组(53例)和急诊
组(67例),两组于术前、术后7 d均行NT-proBNP水平检测和心脏超声射血分数(EF)测定并比较其
结果。急诊组患者随访6个月,根据心血管事件发生情况将患者又分为事件组(15例)与非事件组(52
例)两个亚组,比较两组出院时与随访6个月时的NT-proBNP水平与EF指标;运用Pearson相关性分析法
与Logistic多元回归分析NT-proBNP水平与心血管事件的相关性。结果 急诊组患者术前的NT-proBNP水
平低于择期组(P<0.05),两组术后7 d的NT-proBNP水平均降低(P<0.05),急诊组术后7 d的NTproBNP
水平低于择期组(P<0.05),两组术前、术后7 d的EF比较,差异无统计学意义(P>0.05)。
急诊组中两亚组患者随访6个月时的NT-proBNP水平与出院时相比,在事件组升高(P<0.05),在非
事件组降低(P<0.05);非事件组随访6个月时的NT-proBNP水平低于事件组(P<0.05),EF高于事
件组(P<0.05)。Pearson相关性分析显示,血浆NT-proBNP水平与心血管事件呈正相关性(r=0.802,
P=0.000),Logistic多元回归分析显示,NT-proBNP是心血管事件的独立危险因素(P<0.05)。结论 急
诊PCI可降低急性非ST段抬高型心肌梗死患者NT-proBNP水平,NT-proBNP水平与急诊PCI术后心血管事
件之间存在相关性,对患者生存预测具有一定指导作用。

Abstract:

Objective To analyze the predictive value of plasma N-terminal pro-brain natriuretic peptide
(NT-proBNP) to survival in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) after
percutaneous coronary intervention (PCI), and to provide reference evidence for improving patient’s survival
rate. Methods The patients with acute NSTEMI (n=120) were chosen from Xuanwu Hospital of Capital Medical
University from Sept. 2019 to Mar. 2021. After received PCI, all patients were divided into selective group (n=53)
and emergency group (n=67). The level of NT-proBNP and ejection fraction (EF) were detected and compared in 2
groups before PCI and after PCI for 7 d. The emergency group was followed up for 6 months and divided, according
to occurrence of cardiovascular events, into event subgroup (n=15) and non-event subgroup (n=52). The level of
NT-proBNP and EF index were compared in 2 groups at time of discharge and after follow-up for 6 months. The
correlation between NT-proBNP and cardiovascular events was analyzed by using Pearson correlation analysis and
multivariate Logistic regression analysis. Results The level of NT-proBNP was lower in emergency group than
that in selective group before PCI (P<0.05), and all decreased in 2 groups after PCI fro 7 d (P<0.05). The level of
NT-proBNP was lower in emergency group than that in selective group after PCI fro 7 d (P<0.05). The difference
in EF had no statistical difference in 2 groups before PCI and after PCI for 7 d (P>0.05). The level of NT-proBNP
increased in event subgroup, decreased in non-event subgroup after 6-month follow-up (P<0.05). The level of
NT-proBNP was lower (P<0.05) and EF was higher (P<0.05) in non-event subgroup than those in event subgroup
after 6-month follow-up. The results of Pearson correlation analysis showed that NT-proBNP level was positively
correlated to cardiovascular events (r=0.802, P=0.000). The results of multivariate Logistic regression analysis
showed that NT-proBNP level was an independent risk factor of cardiovascular events (P<0.05). Conclusion Emergency PCI can reduce NT-proBNP level in patients with acute NSTEMI. The level of NT-proBNP is correlated
to cardiovascular events after emergency PCI, which plays a guiding role in predicting the survival in patients.

基金项目:

北京市属医院科研培育计划(PX2019028);首都医科
大学宣武医院2018年度院级课题(XWJL-2018038)

参考文献:

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