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目的研究直接PCI患者左室射血分数(LVEF)与脑型钠尿肽(BNP)之间的相关性,分析LVEF与血BNP对于直接PCI患者预后的预测作用。方法 57例连续选入的接受直接PCI植入支架的急性心肌梗死患者,分别于入院后24h内、1周、2周、1月和6月进行血BNP检测及超声心动图测定LVEF。所有患者随访1年,记录主要不良心脏事件(MACE)发生情况,分析MACE与BNP以及LVEF之间的相关性。结果患者入院后24h内、1周、2周、1月和6月的血BNP与LVEF均呈显著负相关,相关系数r分别为-0.896(P=0.000)、-0.891(P=0.000)、-0.887(P=0.000)、-0.871(P=0.000)和-0.876(P=0.000)。随访1年,共发生MACE36例,MACE与入院后24h(r=0.742,P=0.000)、1周(r=0.719,P=0.000)的血BNP水平呈显著正相关;MACE与入院后24h(r=-0.813,P=0.000)、1周(r=-0.762,P=0.000)、2周(r=-0.867,P=0.000)的LVEF呈显著负相关。多元logistic回归分析显示,入院1周的BNP值以及入院24h的LVEF是MACE的独立预测因子。入院1周BNP的ROC曲线下面积0.812(P=0.000),其面积95%可信区间为[0.729,0.893],不包括0.5;入院1周LVEF的ROC曲线下面积0.822(P=0.000),其面积95%可信区间为[0.764,0.923],也不包括0.5;入院1周的BNP值以及入院1周的LVEF的拐点分别为226.36ng/L和48%。结论对于接受直接PCI植入支架的急性心肌梗死患者,BNP与LVEF预后有密切的关系,尤其是入院1周的BNP值以及入院24h的LVEF可有效预测入院后1年内的MACE事件发生情况。
Objective To investigate the relationship between left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) in patients with direct PCI and to predict the prognostic value of LVEF and BNP in patients with direct PCI. Methods Fifty-seven consecutive patients with acute myocardial infarction undergoing direct PCI were enrolled in this study. Blood BNP and echocardiography were used to measure LVEF at 24h, 1 week, 2 weeks, 1 month and 6 months after admission. All patients were followed up for 1 year, the incidence of major adverse cardiac events (MACE) was recorded, and the correlation between MACE and BNP and LVEF was analyzed. Results There was a significant negative correlation between serum BNP and LVEF at 1 week, 2 weeks, 1 month and 6 months after admission. The correlation coefficients r were -0.896 (P = 0.000), -0.891 (P = 0.000) -0.887 (P = 0.000), -0.871 (P = 0.000) and -0.876 (P = 0.000). A total of 36 MACE patients were followed up for one year. There was a significant positive correlation between MACE and serum levels of BNP at 24 hours after admission (r = 0.742, P = 0.000) and 1 week (r = 0.719, P = 0.000) (r = -0.813, P = 0.000), 1 week (r = -0.762, P = 0.000), 2 weeks (r = -0.867, P = 0.000). Multivariate logistic regression analysis showed that BNP values at 1 week admission and LVEF at admission were independent predictors of MACE. At 1 week after admission, the area under the ROC curve of BNP was 0.812 (P = 0.000), and the 95% confidence interval was [0.729,0.893] excluding 0.5; the area under the ROC curve of LVEF at admission was 0.822 (P = 0.000) The 95% confidence interval was [0.764, 0.923] and did not include 0.5; BNP values at 1 week admission and inflection points at 1 week admission were 226.36 ng / L and 48%, respectively. Conclusions BNP and LVEF prognosis are closely related to the prognosis of patients with acute myocardial infarction who underwent direct PCI implantation. Especially the BNP value of admission one week and the LVEF admission of 24h can predict the occurrence of MACE within one year after admission.