摘要
目的:探讨急性ST段抬高型心肌梗死(ASTEMI)患者血清N末端B型利钠肽前体(NT-proBNP)、P-选择素(P-selectin)联合缺血修饰白蛋白(IMA)预测经皮冠状动脉介入治疗(PCI)术后心电图ST段回落(STR)不良的临床价值。方法:选取2020年1月~2022年7月南京医科大学第二附属医院急诊科收治的100例ASTEMI患者,根据PCI术后心电图STR分为STR不良组和STR良好组,另选取同期50名体检健康志愿者为对照组。采用酶联免疫吸附法检测血清NT-proBNP、P-selectin和IMA水平。采用多因素Logistic回归分析ASTEMI患者PCI术后心电图STR不良的影响因素,采用受试者工作特征(ROC)曲线分析血清NT-proBNP、P-selectin、IMA水平对ASTEMI患者PCI术后心电图STR不良的预测价值。结果:与对照组比较,ASTEMI组PCI术前血清NT-proBNP、P-selectin和IMA水平升高(P<0.05)。根据心电图STR将ASTEMI患者分为STR不良组35例和STR良好组65例。STR不良组与STR良好组PCI术后血清NT-proBNP、P-selectin和IMA水平低于PCI术前(P<0.05);STR不良组PCI术前和PCI术后血清NT-proBNP、P-selectin和IMA水平高于STR良好组(P<0.05)。STR不良组Killip分级≥2级比例和肌钙蛋白I高于STR良好组,ST段偏差总和低于STR良好组(P<0.05)。多因素Logistic回归分析显示,Killip分级≥2级和NT-proBNP、P-selectin、IMA升高为ASTEMI患者PCI术后心电图STR不良的独立危险因素(P<0.05)。ROC曲线分析显示,血清NT-proBNP、P-selectin联合IMA预测ASTEMI患者PCI术后心电图STR不良的曲线下面积(AUC)大于NT-proBNP、P-selectin和IMA单独预测。结论:血清NT-proBNP、P-selectin和IMA水平升高与ASTEMI患者PCI术后心电图STR不良独立相关,三者联合预测ASTEMI患者PCI术后心电图STR不良的价值较高。
Objective:To investigate the clinical value of serum N-terminal pro B type natriuretic peptide(NT-proBNP)and P-se-lectin combined with ischemia-modified albumin(IMA)in predicting poor electrocardiographic ST-segment regression(STR)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(ASTEMI).Methods:100 patients with ASTEMI who were admitted to the emergency Department of the Second Affiliated Hospital of Nanjing Medical University from January 2020 to July 2022 were selected,and they were divided into STR poor group and STR good group according to electrocar-diographic STR after PCI,and 50 healthy volunteers during the same period were selected as control group.Serum NT-proBNP,P-se-lectin and IMA levels were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the in-fluencing factors of poor electrocardiographic STR in patients with ASTEMI after PCI,and the predictive value of serum NT-proBNP,P-selectin and IMA levels in patients with ASTEMI after PCI was analyzed by receiver operating characteristic(ROC)curve.Results:Compared with the control group,the serum NT-proBNP,P-selectin and IMA levels in the ASTEMI group before PCI were increased(P<0.05).According to electrocardiographic STR,patients with ASTEMI were divided into STR poor group of 35 cases and STR good group of 65 cases.The serum NT-proBNP,P-selectin and IMA levels in the STR poor group and STR good group after PCI were lower than those before PCI(P<0.05).The serum NT-proBNP,P-selectin and IMA levels before PCI and after PCI in the STR poor group were higher than those in the STR good group(P<0.05).The proportion of Killip grade≥2 grade and troponin I in the STR poor group were higher than those in the STR good group,and the total deviation of ST segment was lower than that in the STR good group(P<0.05).Multivariate Logistic regression analysis showed that Killip grade≥2 grade and elevated NT-proBNP,P-selectin and IMA were in-dependent risk factors for poor electrocardiographic STR after PCI in patients with ASTEMI(P<0.05).ROC curve analysis showed that the area under curve(AUC)of serum NT-proBNP,P-selectin combined with IMA in predicting poor electrocardiographic STR after PCI in patients with ASTEMI was greater than that predicted by NT-proBNP,P-selectin and IMA alone.Conclusion:Elevated serum NT-proBNP,P-selectin and IMA levels are independently correlated with poor electrocardiographic STR after PCI in patients with ASTEMI,and the combined value of the three is high in predicting poor electrocardiographic STR in patients with ASTEMI after PCI.
作者
史洪伟
许子度
朱舒舒
杜新丽
卫慧
SHI Hong-wei;XU Zi-du;ZHU Shu-shu;DU Xin-li;WEI Hui(Department of Emergency,The Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210011,China;Department of Internal Medicine-Cardiovascular,The Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210011,China)
出处
《现代生物医学进展》
CAS
2023年第21期4048-4053,4012,共7页
Progress in Modern Biomedicine
基金
中华国际医学交流基金会(Z-2019-42-1908-3)。
