AMI患者PCI术后血清BNP、hs-CRP变化及其与预后的关系

目的　探讨急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后血浆B型脑钠肽（BNP）、超敏C反应蛋白（hs-CRP）水平变化及其与预后的关系。方法　选取2019年1月至2020年10月于内蒙古医科大学第三附属医院心血管内科住院治疗的AMI急诊PCI患者160例，男性117例、女性43例，年龄（57.54±11.90）岁，根据随访期间是否发生主要心脏不良事件（MACE）分为预后良好组和预后不良组，另选取80例健康体检人群作为对照组，男性59例、女性21例，年龄（56.96±10.84）岁。比较两组手术前后血清BNP、hs-CRP的变化情况；分析血清BNP、hs-CRP水平与预后的关系。计量资料行t检验，计数资料行χ²检验，曲线下面积（AUC）之间采取Z检验。结果　对AMI患者随访1年，失访5例，失访率为3.13%（5/160）；AMI患者1年内MACE的发生率为27.74%（43/155），根据MACE发生情况将患者分为预后不良组43例和预后良好组112例。AMI患者PCI手术前后血清hs-CRP、BNP水平相比较差异均有统计学意义（均P<0.05），且均高于正常对照组（均P<0.05）。手术前，预后不良组血清hs-CRP、BNP高于预后良好组（均P<0.05）；预后不良组血清hs-CRP手术前后差值大于预后良好组、BNP手术前后差值小于预后良好组（均P<0.05）。根据AUC选取手术前后血清hs-CRP、BNP差值的最佳诊断截点，受试者工作特征曲线（ROC）分析显示，手术前后血清hs-CRP、BNP差值联合预测AMI患者预后的AUC为0.930，高于手术前血清hs-CRP、BNP联合检测的0.777（P<0.05）。结论　AMI患者PCI手术前后BNP、hs-CRP差值对预测其术后发生MACE风险具有较高效能，值得在临床推广应用。

Changes of serum BNP and hs-CRP levels and their predictive values for long-term prognosis in AMI patients after PCI

Objective　To explore the changes in serum levels of brain natriuretic peptide (BNP) and hypersensitive C-reactive protein (hs-CRP) and their predictive values for long-term prognosis in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A total of 160 AMI patients undergoing PCI in Department of Cardiovascular Medicine, The Third Affiliated Hospital of Inner Mongolia Medical University from January 2019 to October 2020 were enrolled, including 117 males and 43 females, aged (57.54±11.90) years. Another 80 healthy controls during the same period were enrolled as a normal group, including 59 males and 21 females, aged (56.96±10.84) years. The AMI patients were followed up for 1 year. According to the presence or absence of major adverse cardiac events (MACE), they were divided into a non-MACE group and a MACE group. The changes of serum BNP and hs-CRP before and after surgery were compared between the two groups, and their predictive values for prognosis in patients with AMI were analyzed. t test was used for the measurement data, χ² test was used for the count data, and Z test was used for the area under curve (AUC). Results　The AMI patients were followed up for 1 year. There were 5 cases (3.13%) lost to follow-up. The incidence of MACE within 1 year in the AMI patients was 27.74% (43/155). According to the presence or absence of MACE, there were 43 cases in the poor prognosis group and 112 cases in the good prognosis group. Before and after surgery, there were statistically significant differences in the serum hs-CRP and BNP levels in the AMI patients (both P<0.05), and the serum hs-CRP and BNP levels in the AMI group were higher than those in the normal group (all P<0.05). Before surgery, the serum hs-CRP and BNP levels in the poor prognosis group were higher than those in the good prognosis group (both P<0.05); the difference of serum hs-CRP before and after surgery in the poor prognosis group was larger than that in the good prognosis group, and the difference of serum BNP before and after surgery was smaller than that in the good prognosis group (both P<0.05). According to the AUC, the optimal diagnostic cut-off points for the differences of serum hs-CRP and BNP before and after surgery were selected. The receiver operating characteristic curve (ROC) analysis showed that the AUC of the combination of differences of serum hs-CRP and BNP before and after surgery to predict the prognosis in AMI patients was 0.930, which was higher than that of the combination of serum hs-CRP and BNP before surgery (0.777) (P<0.05). Conclusion　The combination of differences of serum BNP and hs-CRP in AMI patients before and after PCI has high efficacy in predicting the risk of MACE after PCI, which is worthy of clinical application.