血浆N端B型利钠肽原对前壁与非前壁ST段抬高心肌梗死患者左室收缩功能的预测价值

目的探讨血浆N端B型利钠肽原（NT—proBNP）对急性前壁及非前壁sT段抬高型心肌梗死（STEMI）患者左室射血分数（LVEF）的早期预测价值。方法193例行急诊经皮冠状动脉介入术的STEMI患者，在人院时测量血浆NT—pmBNP水平，并将之以第三四分位数为界分组，分别评价NT—proBNP水平对前壁及非前壁STEMI患者发病6个月后经超声心动图测量的LVEF的预测价值。结果非前壁STEMI患者中NT—proBNP≥310pg／ml组较NT—proBNP〈310pg／ml组的LVEF低（41±12）％比（54±7）％]（P〈0．05）。多元线性回归分析发现，NT—proBNP≥310pg／ml是非前壁STEMI患者LVEF降低的独立预测因子（β=-6．3，P=0．02）。结论在行急诊经皮冠状动脉介入术的非前壁STEMI患者中，入院NT—proBNP≥310pg／ml是6个月时LVEF降低的独立预测因子。入院时测定血浆NT—proBNP可能有助于对急性非前壁STEMI患者进行早期危险分层。

Predictive value of N- terminal pro-brain natriuretic peptide concentration on left ventricular systolic function in patients with anterior versus nonanterior wall ST-elevation myocardial infarction

Objective To investigate the predictive value of plasma N- terminal pro-hrain natriuretic peptide（NT-proBNP） concentration on admission on left ventricular ejection fraction（LVEF） in patients with ante- riot versus nonanterior wall ST-elevation myocardial infarction. Methods One hundred ninety-three patients with ST-elevation myocardial infarctiori undergoing primary percutaneous coronary intervention were prospectively in- cluded. Plasma NT-proBNP was determine on admission and divided into quartiles, which were correlated with LVEF measured by echocardiography at 6-month followed-up. Results Compared to the lower quartiles, patients with nonanterior wall myocardial infarction in the highest quartile of NT-proBNP （≥310 pg/ml） more often had a lower LVEF（41±12）% vs （54±7）%（P〈0.05）. Multivariate analysis revealed that, after adjusting for other serum biomarkers, a NT-proBNP level of ≥310 pg/ml was the independent predictor of LVEF in patients with nonante- rior wall myocardial infarction （/3=-6.3, P=0.02）. Conclusion An admission NT-proBNP level of〉~310 pg}ml independently predict LVEF assessed by echocardiography after nonanterior wall myocardial infarction. The early determination of plasma NT-proBNP upon admission for nonantenor wall STEMI could be helpful identifying patients at higher risk for LV remodeling.