摘要
目的探讨血清高迁移率族蛋白B1(HMGB1)、氨基末端脑钠肽前体(NT-proBNP)水平与中国心肌梗死注册登记研究-ST段抬高型心肌梗死(CAMI-STEMI)评分对ST段抬高型心肌梗死(STEMI)患者经急诊皮冠状动脉介入治疗(PCI)术后生存状况的预测价值.方法选取2015年1月至2017年12月在我院行急诊PCI治疗的269例STEMI患者作为研究对象,根据PCI术后6个月内有无发生主要不良心血管事件(MACE)分为预后良好组和预后不良组.比较两组患者术前血清HMGB1、NT-proBNP水平与CAMI-STEMI评分,应用受试者工作曲线(ROC)的曲线下面积(AUC)评价三者对PCI术后MACE的预测价值,采用多因素Cox回归分析患者PCI术后出现MACE的独立预测因素.结果①PCI术后6个月内共有51例患者发生MACE,发生率为19.0%,其中支架内血栓28例、再发心肌梗死10例、恶性心律失常7例、心力衰竭5例、心源性死亡1例.预后不良组患者术前血清HMGB1、NT-proBNP水平与CAMI-STEMI评分明显高于预后良好组[(3.90±1.36)μg/L比(2.79±1.18)μg/L,(1830.45±237.53)pg/L比(642.02±121.4)pg/L,(3.63±1.33)比(1.96±0.86);P均<0.05].②术前血清HMGB1、NT-proBNP水平、CAMI-STEMI评分对MACE发生具有中等预测价值(AUC分别为0.786、0.792、0.853),三者联合对术后MACE发生的预测价值更高(AUC为0.901).③多因素Cox回归分析结果显示,梗死位于血管近段、发病至心肌再灌注时间、术前血清HMGB1、NT-proBNP水平、CAMI-STEMI评分均是MACE出现的独立影响因素(P<0.05).结论STEMI患者急诊PCI术前血清HMGB1、NT-proBNP水平与CAMI-STEMI评分是术后生存状况的独立预测因素,其中CAMI-STEMI评分价值最高,三者联合的预测效果更佳,值得临床推广应用.
Objective To investigate the predictive value of serum high mobility group box 1 protein(HMGB1),N-terminal pro-brain natriuretic peptide(NT-proBNP)level and China Acute Myocardial Infarction registry-ST segment elevation myocardial infarction(CAMI-STEMI)score for survival after primary percutaneous coronary intervention(PPCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods 269 patients with STEMI receiving PPCI in our hospital from January 2015 to December 2017 were enrolled for the study and divided into poor prognosis group and good prognosis group according to the occurrence of major adverse cardiovascular events(MACE)within 6 months after PPCI.Preoperative serum HMGB1,NT-proBNP levels and CAMI-STEMI score were compared between two groups.Area under curve(AUC)of receiver operating curve(ROC)was perfomed to evaluate the predictive value of three factors for MACE after PPCI.Multivariate COX regression was used to analyze the independent predictors of MACE after PPCI.Results①total of 51patients(19.0%)suffered from MACE within 6 months after PPCI,including 28 cases with recurrent stent thrombosis,10cases with recurrent myocardial infarction,7cases with malignant arrhythmia,5 cases with heart failure and 1 case with cardiac death.Preoperative serum HMGB1,NT-proBNP levels and CAMI-STEMI score in poor prognosis group were significantly higher than those in good prognosis group(3.90±1.36vs 2.79±1.18ug/L,1830.45±237.53 vs 642.02±121.4 pg/L,3.63±1.33 vs 1.96±0.89;p<0.05).②Preoperative serum HMGB1,NT-proBNP level and CAMI-STEMI score had moderate predictive value for occurrence of postoperative MACE(AUC were 0.786,0.792,0.853 respectively),and combination of these three factors had higher predictive value for occurrence of postoperative MACE.③Multivariate COX regression analysis result showed that infarction located in the proximal segment of blood vessel,duration from onset to myocardial reperfusion,preoperative serum HMGB1,NT-proBNP level and CAMI-STEMI score were the independent influencing factors for MACE(P<0.05).Conclusions Serum HMGB1,NT-proBNP level and CAMI-STEMI score before PPCI were the independent predictors of postoperative survival in patients with STEMI,in which the value of CAMI-STEMI score was the highest,and the combined predictive effect of these three factors was better,which was worthy of clinical application.
作者
闫小菊
李勇
郭丽娟
李占虎
李凤德
YAN Xiao-ju;LI Yong;GUO Li-Juan;LI Zhan-hu;LI Feng-de(Department of Cardiology,Harrison International Peace Hospital,Hengshui 053000,China)
出处
《中国心血管病研究》
CAS
2020年第2期105-109,共5页
Chinese Journal of Cardiovascular Research
基金
河北省卫生和计划生育委员会基金项目(20171217)。
