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中国临床药理学与治疗学 ›› 2023, Vol. 28 ›› Issue (6): 658-665.doi: 10.12092/j.issn.1009-2501.2023.06.008

• 药物治疗学 • 上一篇    下一篇

老年急性心肌梗死患者PCI术后血清NT-proBNP水平的影响因素并分析其对近期预后的影响

钱 锦1,王峰岩2   

  1. 1郑州市中心医院,郑州 450000,河南;2河南省职工医院,郑州 450000,河南
  • 收稿日期:2023-04-06 修回日期:2023-05-20 出版日期:2023-06-26 发布日期:2023-07-12
  • 作者简介:钱锦,女,硕士研究生,研究方向:冠心病、高血压、心肌病、心衰。 E-mail: qianjinggg147@163.com
  • 基金资助:
    2019年度河南省医学科技攻关计划联合共建项目(LHGJ20191058)

Influence factors of serum NT-proBNP level in elderly patients with acute myocardial infarction after PCI and its influence on short-term prognosis

QIAN Jin1, WANG Fengyan2   

  1. 1Central Hospital of Zhengzhou, Zhenghzhou 450000, Henan, China;2Henan General Hospital, Zhengzhou 450000, Henan, China
  • Received:2023-04-06 Revised:2023-05-20 Online:2023-06-26 Published:2023-07-12

摘要:

目的:探讨老年急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)术后血清NT-proBNP水平的影响因素,分析其对患者近期预后的预测价值。方法:选取2020年5月至2022年8月我院98例老年AMI患者,均行PCI治疗,检测PCI前后血清NT-proBNP水平,以PCI术后≥125 pg/mL为升高,反之为正常。单因素分析NT-proBNP升高组与正常组一般资料,采用Lasso回归模型筛选筛选变量,再以Logistic回归分析老年AMI患者PCI术后血清NT-proBNP水平的影响因素,对比分析NT-proBNP不同患者预后恢复情况及不同预后患者NT-proBNP水平,绘制ROC曲线分析PCI术后NT-proBNP水平对患者短期预后的预测价值。结果:Logistic回归分析显示,发病至PCI时间、年龄、左心室射血分数(LVEF)、脑卒中、置入支架数目、无复流、支架直径为老年AMI患者PCI术后血清NT-proBNP水平的影响因素。术后随访6个月98例患者不良心血管事件(MACE)发生率为21.43%(21/98),且NT-proBNP升高组发生率为68.00%(17/25),显著高于正常组的5.48%(4/73)(P<0.05);发生MACE组术后NT-proBNP水平显著高于未发生组(P<0.05)。ROC曲线显示,AUC为0.813(95%CI:0.721~0.884),敏感度、特异度分别为80.95%、79.22%,提示PCI术后血清NT-proBNP水平对患者短期预后具有一定预测价值。结论:老年AMI患者PCI术后血清NT-proBNP水平对患者短期预后具有较好的预测能力,综合考虑置入支架数目、是否合并脑卒中、有无复流及年龄等因素以加强对NT-proBNP水平的监测有助于防控MACE的发生,从而改善患者预后。

关键词: 急性心肌梗死, 老年, NT-proBNP, 经皮冠状动脉介入术, 影响因素, 不良心血管事件

Abstract:

AIM: To investigate the influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction (AMI) after PCI, and to analyze its predictive value for the short-term prognosis of patients. METHODS: A total of 98 elderly patients with AMI in our hospital from May 2020 to August 2022 were selected, all of whom underwent PCI. The level of serum NT-proBNP before and after PCI was detected. The level of serum NT-probNP after PCI was ≥125 pg/mL, and the level of serum NT-probNP after PCI was normal. Univariate analysis of the general data of the elevated NT-proBNP group and the normal group, Lasso regression model was used to screen the screening variables, and Logistic regression was used to analyze the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The prognosis recovery of patients with different NT-proBNP and the level of NT-proBNP in patients with different prognosis were compared and analyzed. ROC curve was drawn to analyze the predictive value of NT-proBNP level in patients with short-term prognosis after PCI. RESULTS: Logistic regression analysis showed that the time from onset to PCI, age, left ventricular ejection fraction (LVEF), stroke, number of stents implanted, no recirculation and stent diameter were the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The incidence of adverse cardiovascular events (MACE) was 21.43% (21/98) in 98 patients followed up 6 months after surgery, and the incidence of NT-proBNP increased group was 68.00% (17/25), which was significantly higher than that of normal group (5.48% (4/73)) (P<0.05). The level of NT-proBNP in the group with MACE was significantly higher than that in the group without MACE (P<0.05). ROC curve showed that AUC was 0.813 (95%CI: 0.721-0.884), sensitivity and specificity were 80.95% and 79.22%, respectively, suggesting that serum NT-proBNP level after PCI had certain predictive value for short-term prognosis of patients. CONCLUSION: Serum NT-proBNP level in elderly AMI patients after PCI has a good ability to predict the short-term prognosis of patients. Comprehensive consideration of the number of stents inserted, the presence of stroke, the presence of reflow and age and other factors to strengthen the monitoring of NT-proBNP level is helpful to prevent and control the occurrence of MACE, so as to improve the prognosis of patients.

Key words: acute myocardial infarction, old age, NT-proBNP, PCI, influencing factors, MACE

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