急性心肌梗死急诊行PCI术后患者血清氨基末端脑钠肽前体和脂蛋白a水平变化及其临床意义

doi:10.13481/j.1671-587x.20200123

摘要/Abstract

摘要： 目的：探讨血清氨基末端脑钠肽前体（NT-pro BNP）和脂蛋白a[Lp（a）]水平的变化，阐明其与急性心肌梗死（AMI）行经皮冠状动脉介入术（PCI）患者冠脉病变严重程度及预后的关系。方法：选取行急诊PCI治疗的AMI患者316例。根据冠脉病变支数分为单支病变组135例，双支病变组99例，三支病变组82例；根据Gensini评分分为4组，<38.63分组79例，38.63~56.25分组79例，56.26~83.00分组79例，>83.00分组79例。记录患者的一般资料、生化指标、心脏彩超和冠脉造影等结果，平均随访12个月，记录不良心血管事件（MACE）发生情况。分析血清NT-pro BNP和Lp（a）水平与AMI患者病变支数、Gensini评分及近期发生MACE的关系。绘制受试者工作特征（ROC）曲线，探讨血清NT-pro BNP和Lp（a）水平预测AMI患者近期发生MACE的价值。结果：三支病变组和双支病变组患者血清NT-pro BNP水平明显高于单支病变组（P<0.01），三支病变组患者血清Lp（a）水平高于单支病变组（P<0.05）。Spearman相关分析，AMI患者血清NT-pro BNP和Lp（a）水平与冠脉病变支数之间均存在正相关关系（r=0.285，P<0.01；r=0.144，P=0.01），与冠脉病变Gensini评分之间存在正相关关系（r=0.156，P=0.006；r=0.164，P=0.003）。随访期间发生MACE患者血清NT-pro BNP和Lp（a）水平明显高于无MACE患者（P<0.05）。ROC曲线显示，同时检测血清NT-pro BNP和Lp（a）水平的曲线下面积（AUC）为0.747（95% CI：0.679~0.814）。结论：血清NT-pro BNP和Lp（a）水平与AMI行急诊PCI治疗患者的冠脉病变严重程度有一定的关系，同时检测NT-pro BNP和Lp（a）水平对AMI行急诊PCI治疗患者近期发生MACE具有一定的预测价值。

关键词: 氨基末端脑钠肽前体, 脂蛋白a, 急性心肌梗死, Gensini评分, 冠脉病变支数, 主要不良心血管事件

Abstract: Objective: To investigate the changes of the levels of amino-terminal pro-brain natriuretic peptide (NT-pro BNP) and lipoprotein a[Lp(a)], and to clarify the relationships between the severity of coronary artery lesions and the prognosis in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: A total of 316 AMI patients underwent emergency PCI were selected. According to the number of stenosed coronary vessels, the patients were divided into single-vessel disease group(n=135), double-vessel disease group(n=99) and three-vessel disease group(n=82). According to the Gensini score, there were 79 cases in <38.63 group, 79 cases in 38.63-56.25 group, 79 cases in 56.26-83.00 group, and 79 cases in >83.00 group. The patients' general data, biochemical parameters, echocardiography results, and coronary angiography findings were recorded, and the major adverse cardiovascular events (MACE) were also recorded during a 12-month follow-up. The relationships between the serum NT-pro BNP and Lp(a) levels of the AMI patients in different lesion counts and Gensini scores, and the recent occurrence of MACE were analyzed. The receiver operating characteristic (ROC) curve was drawn to investigate the values of NT-pro BNP and Lp(a) levels on predicting the recent MACE in the patients with AMI. Results: The serum NT-pro BNP levels of the patients in three-vessel disease group and double-vessel disease group were higher than that in single-vessel disease group (P<0.01); the serum Lp(a) level of the patients in three-vessel disease group was higher than that in single-vessel disease group (P<0.05). According to Spearman correlation analysis, there were positive correlations between the serum NT-pro BNP level, Lp(a) level of the AMI patients and the number of coronary vessels(r=0.285, P<0.01;r=0.144, P=0.010); there were positive correlation between the serum NT-pro BNP level, Lp(a) level and Gensini score of coronary lesions (r=0.156, P=0.006;r=0.164, P=0.003). The serum NT-pro BNP and Lp(a) levels of the patients with MACE during follow-up were higher than those in the patients without MACE.The ROC curve showed that the area under the curve(AUC) of the levels of serum NT-pro BNP and Lp(a) was 0.747 (95%CI: 0.679-0.814). Conclusion: The serum NT-pro BNP and Lp(a) levels have the certain relationships with the severity of coronary artery lesions in the AMI patients after PCI. The simultaneous detection of serum NT-pro BNP and Lp(a) levels has certain predictive value for the recent occurrence of MACE in the AMI patients underwent emergency PCI.

Key words: N-terminal pro-BNP, lipoprotein(a), acute myocardial infarction, Gensini score, coronary artery disease count, major adverse cardiovascular events

中图分类号:

R542.22

徐小燕, 宋子凯, 张洋, 秦玲. 急性心肌梗死急诊行PCI术后患者血清氨基末端脑钠肽前体和脂蛋白a水平变化及其临床意义[J]. 吉林大学学报(医学版), 2020, 46(01): 132-137.

XU Xiaoyan, SONG Zikai, ZHANG Yang, QIN Ling. Changes of serum NT-pro BNP and Lp(a) levels in patients with acute myocardial infarction after emergency PCI and their clinical significances[J]. Journal of Jilin University(Medicine Edition), 2020, 46(01): 132-137.

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