Predictive effect of plasma brain natriuretic peptide combined with cTnT and D-Dimer on short-term adverse prognosis after PCI
-
摘要: 目的:观察血浆BNP联合cTnT、D-二聚体在预测PCI术后近期不良预后的效能。方法:以152例因急性ST段抬高型心肌梗死接受PCI治疗的病例为研究对象。记录PCI术后近期(3个月)不良预后情况,分析预后不良者与预后良好者的基线资料及血浆病情相关指标差异,采用多因素回归分析法分析预后不良的影响因素,以ROC曲线图进行指标临床预后预测效能分析。结果:152例PCI患者术后3月预后不良率为17.11%(26例),预后不良者与预后良好者在血压(收缩压、舒张压)、是否吸烟、血浆病情相关指标(cTnT、D-二聚体、BNP)上比较(P<0.05)。BNP、cTnT、D-二聚体均是PCI术后近期预后不良的危险因素(OR=2.156,1.522,1.565;均P<0.05)。ROC曲线分析显示:BNP、cTnT、D-二聚体三者联合预测不良预后的敏感度(92.74%)、特异度(90.73%)、准确性(89.78%)均优于单纯BNP(75.63%、74.48%、69.83%)、单纯cTnT(72.12%、74.38%、70.79%)、单纯D-二聚体(72.12%、74.38%、70.79%)(P<0.05)。结论:血清cTn、BNP、D-二聚体水平均可对PCI术的近期不良预后产生影响,相比与单纯BNP、单纯cTnT、单纯D-二聚体,三者联合的PCI术后近期不良预后的预测效能更佳。Abstract: Objective: To observe the effect of plasma BNP combined with cTnT and D-Dimer in predicting the short-term adverse prognosis after PCI. Method: A total of 152 patients with ST-segment elevation myocardial infarction(ST-segment elevation myocardial infarction) were treated with PCI(time range: 2018.1-2018.12). The short-term(3 months) adverse prognosis after PCI was recorded, and the baseline data and plasma disease-related indicators of patients with poor prognosis and good prognosis were analyzed. Multivariate regression analysis was used to analyze the influencing factors of poor prognosis, and ROC curve was used to analyze the predictive efficacy of clinical prognosis. Result: The poor prognosis rate of 152 patients with PCI was 17.11%(26 cases) in 3 months after operation. The poor prognosis patients were compared with those with good prognosis in blood pressure(systolic blood pressure, diastolic blood pressure), smoking or not, plasma disease-related indicators(cTnT, D-Dimer, BNP)(P<0.05). BNP, cTnT and D-Dimer were risk factors for poor prognosis after PCI(OR=2.156, 1.522, 1.565; P<0.05). ROC curve analysis showed that the sensitivity(92.74%), specificity(90.73%) and accuracy(89.78%) of BNP, cTnT and D-Dimer were better than those of BNP alone(75.63%, 74.48%, 69.83%), cTnT alone(72.12%, 74.38%, 70.79%) and D-Dimer alone(72.12%, 74.38%, 70.79%)(P<0.05).Conclusion: Serum levels of cTn, BNP and D-Dimer can affect the short-term adverse prognosis of PCI. Compared with BNP, cTnT and D-Dimer alone, the combination of them has better predictive effect on the short-term adverse prognosis of PCI.
-
[1] Hausenloy DJ,Yellon DM.Myocardial ischemia-reperfusion injury:a neglected therapeutic target[J].J Clin Invest,2018,123(26):92-100.
[2] 冯桂荣.尿激酶联合阿托伐他汀钙片对ST段抬高型心肌梗死患者的治疗价值[J].中国药物经济学,2016,(13):256-259.
[3] 赵学.急性心肌梗死合并多支血管病变的治疗原则[J].医学与哲学,2015,14(4):203-208.
[4] 乔福斌,何艳丽,卢峰,等.替罗非班在心肌梗死并发代谢综合征行PCI手术患者中的应用效果[J].贵州医药,2017,14(9):314-317.
[5] 李岩锋,张兴雨.256-MSCT联合血清BNP、hs-cTnT水平监测在急性冠状动脉综合征患者病情评估中的应用价值[J].河南医学研究,2018,27(22):4065-4067.
[6] 中华医学会心血管分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病学杂志,2010,38(6):675-690
[7] Cohen MV,Downey JM.Is it time to translate ischemic preconditioning’s mechanism of cardioprotection into clinical practice?[J].Cardiovasc Pharmacol Ther,2016,16(21):273-280.
[8] 余尚贤.阿托伐他汀序贯治疗对急性ST段抬高型心肌梗死患者PCI术后血清内脂素和Syndecan-4水平的影响[J].河北医药,2017,14(1):311-314.
[9] Staat P,Rioufol G,Piot C,et al.Postconditioning the human heart[J].Circulation,2015,112(26):2143-2148.
[10] 朱薇超,齐晓勇,党懿,等.冠脉内溶栓对改善ST段抬高型心肌梗死心肌灌注的研究进展[J].中国新药杂志,2017,12(4):246-249.
[11] 倪沈锋,黄冬娟.不同性别老年急性心肌梗死患者的血脂特点及其与冠状动脉病变程度的关系分析[J].检验医学与临床,2019,16(15):2224-2226.
[12] 张艳堂,高文涛.急性心肌梗死患者心率变异性与血清Hcy、pro-BNP水平的关系[J].临床医学研究与实践,2019,4(21):73-74.
[13] Sorensson P,Saleh N,Bouvier F,et al.Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction[J].Heart,2016,96(19):1710-1715.
[14] 余硕锻,叶钦.NT-pro-BNP与急性心肌梗死患者心功能的关系及对预后的反应价值探究[J].中国医学创新,2019,16(19):157-160.
[15] 杨燕娟.联合检测血清cTnT、NT-proBNP、Myo在急性心肌梗死诊断中的价值[J].中国医药指南,2019,17(13):6-7.
[16] 安蓉,刘黎明.cTnI、cTnT检测对急性心肌梗死诊断的应用价值分析[J].检验医学与临床,2019,16(8):1139-1141.
[17] 罗常有,王善花,姜华丽,等.超敏心肌肌钙蛋白I联合D-二聚体对急性主动脉夹层与急性心肌梗死的鉴别诊断价值[J].实用心脑肺血管病杂志,2019,27(6):53-57.
[18] Tarantini G,Favaretto E,Marra MP,et al.Postconditioning during coronary angioplasty in acute myocardial infarction:the POST-AMI trial[J].Int J Cardiol,2016,162(38):33-38.
[19] 秦艳波,秦大鹏,王慧,等.血清D-二聚体水平预测急性心肌梗死患者预后的价值分析[J].内科,2018,13(5):747-749,811.
[20] 胡铂,康晟,赵小红,等.D-二聚体与老年急性心肌梗死冠状动脉介入术后无复流的相关性研究[J].中华老年心脑血管病杂志,2018,20(10):1037-1040.
计量
- 文章访问数: 82
- PDF下载数: 53
- 施引文献: 0