N端脑钠肽前体预测首次急性心肌梗死后新发心房颤动的价值研究

doi:10.16150/j.1671-2870.2020.03.018

摘要/Abstract

摘要：

目的： 探讨首次急性心肌梗死患者入院时的血浆N端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）水平与其新发心房颤动（房颤）间的关系。方法： 测定236例首次急性心肌梗死（心梗）入院患者入院时以及急诊经皮冠状动脉介入术（percutaneous coronary intervention, PCI）术后1 d、3 d、7 d的血浆NT-proBNP水平,并持续监测患者入院7 d内有无房颤发作,根据结果将患者分为房颤组（n=51）和无房颤组（n=185）。分析患者的临床资料、心脏超声和冠状动脉造影资料,应用受试者操作特征曲线（receiver operator characteristic curve, ROC 曲线）分析NT-proBNP预测急性心梗患者新发房颤的临界值,采用多因素Cox回归分析评价NT-proBNP水平对急性心梗后新发房颤的预测价值。结果： 急性心梗后的新发房颤率为21.6%。单因素分析发现,房颤组患者的年龄、左心房内径、C反应蛋白（C reactive protein, CRP）水平以及合并高血压、前壁心梗、左前降支和三支血管病变的构成比均显著高于无房颤组;房颤组患者的左心室射血分数显著低于无房颤组;房颤组患者的NT-proBNP水平无论在入院时,还是术后1 d、3 d和7 d均显著高于无房颤组（P<0.05）。ROC曲线显示,入院时NT-proBNP水平预测急性心梗患者新发房颤的曲线下面积为0.74（95%CI为0.60~0.90, P<0.01）,最佳临界值为1 403.6 ng/L。多因素Cox回归分析显示,NT-proBNP>1 403.6 ng/L（OR=1.8, 95%CI为1.3~2.4）、年龄>69岁（OR=1.6, 95%CI为1.3~3.1）和左心房内径 >43.8 mm（OR=1.3, 95%CI为1.1~1.9）是首次心梗患者新发房颤的独立预测因素（P<0.05）。结论： 血浆NT-proBNP水平检测在早期预测急性心梗后新发房颤中有一定的临床价值。

关键词: N端脑钠肽前体, 急性心肌梗死, 新发心房颤动

Abstract:

Objective: To investigate relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) level and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). Methods: A total of 236 AMI patients admitted within 24 hours of onset were tested for NT-proBNP level upon admission, and 1day, 3 days, and 7 days after primary percutaneous coronary intervention (PCI). All patients were monitored continuously for new-onset AF for 7 days, and were later divided into AF group (n=51) and non-AF group (n=185). Clinical manifestations, echocardiographic and angiographic data were also reviewed in all patients. The impact of NT-proBNP level on new-onset AF following initial AMI was analyzed with multi-factor Cox regression analysis.The receiver operator characteristic curve (ROC curve) was used to determine the predictive cutoff value of NT-proBNP for the occurrence of new-onset atrial fibrillation following initial AMI. Results: AF occurred in 21.6% of patients. The univariate analysis showed that patients with new-onset AF had an older age, larger left atrial diameter (LAD), higher C reactive protein （CRP）level,higher percentage of the population with high blood pressure, anterior AMI, left-anterior-descending-artery lesion and 3-vessel lesion, and lower left ventricular ejection fraction （P<0.05）. Levels of NT-proBNP were higher in patients with AF than those in patients without at any point of test (P<0.05). Area under ROC (AUC) of NT-proBNP to predict new-onset AF was 0.74（95%CI 0.60-0.90, P<0.01）, with an optimal cut-off value of 1 403.6 pg/mL. Multivariate analysis showed that NT-proBNP level (>1 403.6 pg/mL)(OR=1.8, 95%CI 1.3-2.4), age(>69 years old)（OR=1.6, 95%CI 1.3-3.1） and LAD(>43.8 mm) (OR=1.3, 95%CI为1.1-1.9) were independent predictors of occurrence of new-onset AF. Conclusion: Serum NT-proBNP level is of certain value in early prediction of the new-onset AF following AMI.

Key words: N-terminal pro-brain natriuretic peptide, Acute myocardial infarction, New-onset atrial fibrillation

中图分类号:

R541.75

罗晓颖, 许燕, 张建盛, 吴立群, 戚文航. N端脑钠肽前体预测首次急性心肌梗死后新发心房颤动的价值研究[J]. 诊断学理论与实践, 2020, 19(03): 303-307.

LUO Xiaoying, XU Yan, ZHANG Jiansheng, WU Liqun, QI Wenhang. Predictive value of NT-proBNP for new-onset atrial fibrillation following acute myocardial infarction[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(03): 303-307.

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参考文献 14

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参数	房颤组（n=51）	非房颤组（n=185）
年龄（岁）	69.0±10.5^a)	60.2±12.3
性别（男/女）	21/30	107/78
高血压（%）	71.0^a)	50.5
糖尿病（%）	53.2	49.1
吸烟（%）	25.7	29.5
入院时心率（次/分）	77.8±13.1	80.3±22.2
Killip分级Ⅱ~Ⅳ（%）	44.5	41.5
心梗部位（%）前壁下壁侧壁后壁右心室	67.7^a) 36.6 18.2 9.2 13.1	47.6 40.3 16.0 10.5 11.2
CK-MB峰值（U/L）	303.7±177.2	289.6±202.1
血清肌酐（mmol/L）	94.5±38.0	103.1±52.3
CRP（mg/L）	17.7±10.6^a)	13.1±12.7
药物（%）氯比格雷阿司匹林 ACEI和（或）ARB β受体阻滞剂他汀类药物硝酸酯类药物	100 93.1 87.5 79.3 98.4 32.0	100 97.2 93.2 83.5 97.1 29.3

参数	房颤组（n=51）	非房颤组（n=185）
病变部位（%）左前降支回旋支右冠左主干	71.0^a) 21.7 30.8 2.7	46.7 28.3 34.7 0
病变数目（%） 1支 2支 3支	58.1 19.6 22.6^a)	65.0 25.6 8.6

参数	房颤组（n=51）	非房颤组（n=185）
左心室舒张末期内径(mm）	52.7±16.5	50.2±18.1
左心室收缩末期内径(mm)	38.8±11.3^a)	30.3±13.5
左心室射血分数(%)	47.7±10.7^a)	53.8±12.4
左心房内径(mm)	43.8±5.2^a)	34.5±3.6
E/A比值	0.9±0.3	1.2±0.6

参数	房颤组（n=51）	非房颤组（n=185）
入院	2 011.4±516.5^a)	985.2±318.1
术后1 d	1 237.8±411.3^a)	630.3±293.5
术后3 d	947.7±390.7^a)	553.8±212.4
术后7 d	636.8±345.2^a)	484.5±193.6