AMI患者血清NT-proBNP水平在预测心脏功能中的临床意义

目的通过观察急性心肌梗死(acutemyocardialinfarction,AMI)患者在发病后第3天血清N末端B型脑钠尿肽前体(N-terminalpro-brainnatriureticpeptide,NT-proBNP)的水平与患者发病后3个月时左室舒末容积的增加率之间的关系,探讨预测AMI晚期左室重构的指标。方法选择2004年6月至2005年4月于北京大学第三医院诊断为前壁、前间壁及前侧壁AMI的患者106例,分别在患者发病后第3天和3个月时做超声心动图测定左室舒末容积,依据左室舒末容积的增加率(目前我国诊断左室重构的指标之一,cutoff值定为0.2),将患者分为左室重构组及非左室重构组;于发病后第3天采集患者空腹静脉血,采用电化学免疫发光法检测血清NT-proBNP水平。结果AMI发病后第3天,左室重构组,血清NT-proBNP平均为1819.0(1009.5～4601.5)pg/ml;无左室重构组,血清NT-proBNP平均为504.15(212.50～856.25)pg/ml,两组比较有显著性差异(P<0.05)。患者发病后3个月时左室舒末容积较基础值增加率与NT-proBNP水平的相关系数为0.702(P<0.001)。血清NT-proBNP的受试者工作特征曲线(receiveroperatingcharacteristiccurve,ROC曲线)下面积为0.892,当预测特异度为81.8%时,NT-proBNP的敏感度为83.3%;在预测敏感度为98.8%,NT-proBNP的特异度为36.4%,其cutoff值为952pg/ml。结论AMI患者血清NT-proBNP水平是评估AMI后晚期心脏功能的较理想指标。

The predictive value of serum levels of N-terminal pro-brain natriuretic peptide in left ventricular remodeling after acute myocardial infarction

Objective This study was designed to observe the correlation between the levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP), on the 3rd day after acute myocardial infarction (AMI) and left ventricular remodeling 3 months later to evaluate the predictive levels of NT-proBNP for left ventricular remodeling after AMI. Methods One hundred and six patients with first AMI from June 2004 to April 2005 in the third hospital of Peking university were examined on 3rd day, 3 months with blood samples and echocardiography. Left ventricular remodeling is estimated by the change of left ventricular end-diastolic volume(LVEDV) between 3rd day and 3 months. Based on the change of LVEDV, the 106 patients were divided into two groups: left ventricular remodeling group and non- left ventricular remodeling group. The blood samples were collected on the 3rd day, and the levels of serum NT-proBNP were examined using electro-chemiluminescence immunoassay. Results The average levels of serum NT-proBNP in left ventricular remodeling group were 1 819.0 (1 009.5~4 601.5) pg/ml, and in non-left ventricular remodeling group were 504.15 (212.50~856.25) pg/ml. There were significant difference between the two groups(P< 0.05). The correlation coefficients with the change of LVEDV were 0.702 for serum NT-pro BNP. With a cut off value of 952 pg/ml, the area under the receiver operating characteristic curve(AUCs) was 0.892. NT-proBNP's specificity is 83.3% when predict sensitivity is 81.8%. NT-proBNP's specificity is 36.4% when predict sensitivity is 98.8%. Conclusion The level of serum of NT-proBNP appropriately reflects heart function after AMI.