急性心肌梗死患者经皮冠状动脉介入治疗后血清sST2、NT-proBNP浓度预测心力衰竭的价值

目的探讨急性心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后血清可溶性致癌抑制因子2(solube suppression tumorigenicity 2,sST2)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度对心力衰竭的预测价值。方法选取2015年6月至2018年10月六安市人民医院收治的120例急性心肌梗死患者,均行PCI治疗。对比入院时、术后即刻、术后24 h及术后72 h的血清sST2、NT-proBNP浓度;另随访6个月,根据患者是否发生心力衰竭情况将其分为心力衰竭组与未心力衰竭组,比较2组血清sST2、NT-proBNP浓度,且采用Logistic回归分析法分析其对急性心肌梗死PCI治疗后发生心力衰竭的预测价值。结果患者术后即刻及术后24 h的血清sST2及NT-proBNP浓度均明显高于入院时,差异有统计学意义(P<0.05);术后24 h及术后72 h的血清sST2及NT-proBNP浓度均明显低于术后即刻,差异有统计学意义(P<0.05);术后72 h的血清sST2及NT-proBNP浓度均明显低于术后24 h及入院时,差异有统计学意义(P<0.05)。120例患者随访期间共有23例出现心力衰竭,发生率为19.17%;心力衰竭组术后即刻血清sST2及NT-proBNP浓度均明显高于未心力衰竭组,差异有统计学意义(P<0.05)。经Logistic回归分析发现,年龄≥60岁、多个部位梗死、病变支数≥2支、左心室射血分数(LVEF)<50%、并发原发性高血压(高血压)、并发糖尿病、并发高脂血症、有吸烟史、发病至行PCI治疗时间≥12 h、术后即刻sST2浓度>56.68 ng/mL、术后即刻NT-proBNP浓度≥2853.14 pg/mL、PCI治疗后慢或无复流均是急性心肌梗死患者行PCI治疗后发生心力衰竭的危险因素(OR=2.085、2.568、2.375、3.056、2.740、2.241、2.188、2.314、3.374、3.031、4.035,P<0.05)。结论急性心肌梗死患者PCI治疗后短期内血清sST2、NT-proBNP浓度呈现不同程度的升高,但随着时间的推移呈逐渐降低趋势,另术后发生心力衰竭患者血清sST2、NT-proBNP浓度明显高于未发生者,且术后即刻sST2浓度>56.68 ng/mL、术后即刻NT-proBNP浓度≥2853.14 pg/mL、PCI治疗后慢或无复流以及年龄≥60岁等均可增加心力衰竭发生风险。

Value of serum concentrations of sST2 and NT-proBNP in predicting heart failure after percutaneous coronary intervention in patients with acute myocardial infarction

Objectives To explore the predictive value of serum concentrations of solube suppression tumorigenicity 2(sST2)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with acute myocardial infarction afterpercutaneous coronary intervention(PCI)for heart failure.MethodsTotally 120 patients with acute myocardial infarc-tion admitted to Liuan People’s Hospital from June 2015 to October 2018 were selected,who were treated with PCI.Serum concentrations of sST2 and NT-proBNP at admission,immediately after PCI,24 h after PCI and 72 h after PCIwere compared.The patients were followed up for 6 months and divided into heart failure group and non-heart failuregroup according to whether or not with heart failure,and serum concentrations of sST2 and NT-proBNP were comparedbetween the two groups.Then the predictive value for heart failure in patients with acute myocardial infarction undergo-ing PCI was analyzed by Logistic regression analysis method.ResultsSerum concentrations of sST2 and NT-proBNPat immediately after PCI and 24 h after PCI were significantly higher than those at admission(P<0.05).Serum concen-tration of sST2 and NT-proBNP at 24 h and 72 h after PCI were significantly lower than those at immediately after PCI(P<0.05).Serum concentration of sST2 and NT-proBNP at 72 h after PCI were significantly lower than those at 24 h andat admission(P<0.05).During the follow-up period,there were 23 cases of heart failure in 120 patients with acute myo-cardial infarction undergoing PCI,and the incidence rate was 19.17%.Serum concentrations of sST2 and NT-proBNPat immediately after PCI of heart failure group were significantly higher than those of non-heart failure group(P<0.05).Logistic regression analysis showed that age≥60 years old,multiple site infarction,lesion branches≥2 branches,left ventricular ejection fraction(LVEF)<50%,hypertension,diabetes mellitus,duration of morbidity to PCI≥12 h,smoking,hyperlipidemia,sST2≥56.68 ng/mL at immediately after PCI,NT-proBNP≥2853.14 pg/mL at immediatelyafter PCI and slow or no reflow after PCI were risk factors for heart failure after PCI(OR=2.085,2.568,2.375,3.056,2.740,2.241,2.188,2.314,3.374,3.031,4.035,P<0.05).ConclusionsSerum concentrations of sST2 andNT-proBNP in patients with acute myocardial infarction after PCI increase in different degrees in the short time,but de-crease gradually with the passage of time.Serum concentrations of sST2 and NT-proBNP in patients with heart failurepost-PCI are significantly higher than those in patients without heart failure.Serum concentration of sST2≥56.68 ng/mL at immediately after PCI,serum concentration of NT-proBNP≥2853.14 pg/mL at immediately after PCI,slow or noreflow after PCI and age≥60 years old and so on can increase the risk of heart failure.