B型钠尿肽对急性心肌梗死早期介入治疗预后的预测价值

目的探讨急性心肌梗死(AMI)患者早期血运重建后,B型钠尿肽(BNP)水平的变化及其对患者2年内心血管不良事件的预测价值。方法入选首次ST段抬高AMI住院患者114例,测定入选时,入院后第1、7天的血浆BNP水平,根据发病6 h内梗死相关血管(IRA)开通情况分为:开通组69例和未开通组45例,入院后7 d内行超声心动图检查,出院后随访2年,记录其临床事件。结果开通组与未开通组血浆BNP水平在入院时差异无统计学意义,未开通组血浆BNP水平在第1、7天较开通组明显升高(P0.01)。多元COX回归分析显示,Killip分级、入院第1天BNP经自然对数转换后的数值及发病6 h内IRA状态是AMI后2年内心血管不良事件的危险因素(P0.05,P0.01)。ROC曲线显示,第1天的血浆BNP能够预测AMI后2年内的心血管不良事件,其分界值332 ng/L时的敏感性为76.9%,特异性为73.3%。结论血浆BNP水平是AMI不良预后的独立危险因素,BNP的动态变化支持早期开通IRA在改善近、远期预后方面的重要性。

The predictive value of plasma B-type natriuretic peptide for prognosis of acute myocardial infarction after early intervention

Objective To explore change of the level of BNP after early revascularization in patients with acute myocardial infarction ( AMI) ,and the value of BNP for predicting cardiovascular adverse events within 2 years.Methods 114 patients with AMI for the first time were enrolled.The levels of plasma BNP were measured on admission and on first and 7th days after admission.According to the status of infarct-related artery within 6 hours after onset of disease,the patients were divided into patent group and occluded group.All patients were followed up for 24 months, and clinical events were recorded.Results The levels of BNP on admission were not different between the two groups,but on first and 7th days the levels in occluded group were significantly higher (P < 0.01).Multirariate cox regression analysis showed that BNP on first day,Killip classification and the status of infarct-related artery within 6 hours were the independent risk factors for cardiovascular adverse events within 2 years after AMI (P<0.05 ,P < 0.01).ROC curves indicated that levels of BNP on fist day could predict cardiovascular adverse events within 2 years after AMI.Its sensitivity and specificity at the cut-off point value of 332 ng/L were 76.9% and 73.3% respectively.Conclusion The level of plasma BNP was an independent risk factor for poor prognosis of AMI.Moreover the importance of early revascularization in improving short-and long-term prognosis is supported by BNP kinetic changes.