血尿酸及D-二聚体水平对急性心肌梗死合并心力衰竭的近期预后价值探讨

目的:探讨血尿酸及D-二聚体（D-dimer）水平对急性心肌梗死（AMI）合并心力衰竭的近期预后价值。方法:选取2020年1月1日—2020年12月31日泰达国际心血管病医院心内科330例AMI患者作为研究对象，根据有无心力衰竭将患者分为心力衰竭组（左心力衰竭）（n=119）与非心力衰竭组（n=211），根据Killip分级将心力衰竭组患者分为Ⅱ级（n=99）、Ⅲ级（n=10）、Ⅳ级（n=10），检测两组入院时尿酸、D-dimer、左心室射血分数（LVEF）、脑钠利尿肽（BNP）、左心室舒张末内径（LV）、左心房内径（LA）、心室舒张早期血流峰值速度/心室舒张晚期血流峰值速度（E/A）水平，并比较心力衰竭组不同Killip分级尿酸、D-dimer、LVEF、BNP、LV、LA、E/A水平，分析尿酸、D-dimer水平与Killip分级及LVEF的相关性，评估联合尿酸、D-dimer检测对AMI后心力衰竭的诊断价值；随访两组室壁瘤、室速、死亡等并发症发生率。结果:心力衰竭组尿酸、D-dimer、BNP、LV、LA高于非心力衰竭组，LVEF、E/A低于非心力衰竭组（均P<0.05）；不同Killip分级尿酸、D-dimer、BNP水平Ⅳ级患者显著高于Ⅱ级、Ⅲ级，LVEF低于Ⅱ级、Ⅲ级（均P<0.05）；尿酸、D-dimer水平与Killip分级呈正相关，与LVEF呈负相关（均P<0.05）；联合检测尿酸、D-dimer对AMI后心力衰竭敏感性、特异性分别为87.4%、89.4%；心力衰竭组室壁瘤、死亡发生率高于非心力衰竭组（均P<0.05）。结论:尿酸、D-dimer水平联合检测能够预测AMI后心力衰竭风险，预测患者预后，敏感性、特异性高，具有较高临床价值。

The value of serum uric acid and D-dimer levels in the short-term prognosis of acute myocardial infarction complicated with heart failure

Objective: To investigate the short-term prognostic value of serum uric acid and D-dimer levels in patients with acute myocardial infarction（AMI） complicated with heart failure. Methods: A total of 330 patients with AMI in the Department of Cardiology，TEDA International Cardiovascular Hospital from 2020.1.1 to 2020.12.31 were selected as the research objects.The patients were divided into heart failure group（left heart failure）（n=119） and non-heart failure group（n=211） according to the presence or absence of heart failure. Patients in the heart failure group were divided into grade Ⅱ（n=99）， grade Ⅲ（n=10） and grade Ⅳ（n=10） according to Killip grade. The levels of uric acid， D-dimer， left ventricular ejection fraction（LVEF）， Brain natriuretic peptide（BNP）， left ventricular end diastolic inner diameter（LV）， left atrial inner diameter（LA）， ventricular early diastolic peak flow velocity / ventricular late diastolic peak flow velocity（E/A） in the two groups were detected at admission and were analyzed according to different Killip grade. The correlation of uric acid and D-dimer levels with Killip grade and LVEF was analyzed to evaluate the diagnostic value of combined uric acid and D-dimer detection for heart failure after AMI. Ventricular aneurysm， ventricular tachycardia， death and other complications were followed of two groups. Results: The levels of uric acid， D-dimer，BNP，LV and LA in the heart failure group were higher than those in the non-heart failure group， and the LVEF，E/A in the heart failure group was lower than that in the non-heart failure group（all P<0.05）；the levels of uric acid， D-dimer and BNP ingradeⅣ patients with different Killip grades were significantly higher than those in heart function gradeⅡ andⅢ， and the LVEF was lower than the in gradeⅡand Ⅲ， and the difference was statistically significant（all P<0.05）. The levels of uric acid and D-dimer were positively correlated with Killip grade and were negatively correlated with LVEF， and the difference was statistically significant（all P<0.05）. The sensitivity and specificity of combined detection of uric acid and D-dimer for heart failure after AMI were 87.4% and 89.4%. Entricular aneurysm， mortality rate of the heart failure group was higher than that of the non-heart failure group， and the difference was statistically significant（all P<0.05）. Conclusion: The combined detection of uric acid and D-dimer levels can predict the risk of heart failure after AMI and the prognosis of patients with high sensitivity and specificity, and it has high clinical value.