N端脑钠肽前体、中性粒细胞/淋巴细胞比率联合定量组织速度成像对急诊PCI患者术后发生心功能不全的预测价值-东南大学学报医学版

N端脑钠肽前体、中性粒细胞/淋巴细胞比率联合定量组织速度成像对急诊PCI患者术后发生心功能不全的预测价值

单位：哈励逊国际和平医院心内科, 河北衡水 053000

关键词：N端脑钠肽前体中性粒细胞/淋巴细胞比率定量组织速度成像急诊PCI 心功能不全

分类号：R542.2+2

出版年·卷·期（页码）：2018·37·第一期（78-82）

摘要：

目的：探讨N端脑钠肽前体（NT-proBNP）、中性粒细胞/淋巴细胞比率（NLR）联合定量组织速度成像对急性ST段抬高心肌梗死患者急诊PCI术后发生心功能不全的预测价值。方法：入选急性ST段抬高心肌梗死并接受急诊PCI患者132例，所有患者均于术前测定NT-proBNP、NLR，应用定量组织速度成像技术测量病变血管相应节段收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）和舒张晚期峰值速度（Va），并计算平均组织速度（mVs、mVe、mVa）以及mVe/mVa。PCI术后随访30 d，根据是否发生心功能不全，将患者分为发生心功能不全组（n=27）和非心功能不全组（n=105），对比两组之间各项指标的差异。结果：发生心功能不全组患者的术前NT-proBNP、NLR均显著高于非心功能不全组（1 369.53±293.23 vs 346.18±39.9 pg·ml^-1，P<0.01；8.24±0.42 vs 5.49±0.25，P<0.05），mVs、mVe/mVa均低于非心功能不全组（3.16±1.21 vs 5.64±1.48 cm·s^-1；0.96±0.47 vs 1.88±0.76，P<0.05）。相关分析显示，NT-proBNP与NLR呈正相关（r=0.264，P<0.01），NT-proBNP、NLR均与mVs、mVe/mVa呈负相关（r=-0.399，P<0.05；r=-0.146，P<0.05；r=-0.401，P<0.01；r=-0.584，P<0.05）。多变量Logistic回归分析显示，NT-proBNP>1 000 pg·ml^-1（P=0.014，OR=1.738，95%CI：1.088~9.543），NLR>6.85（P=0.021，OR=2.104，95%CI：1.274~10.652），mVs<4.5 cm ·s^-1（P=0.018，OR=1.886，95%CI：1.030~5.747）是心功能不全发生的独立危险因素。结论：NT-proBNP、NLR联合mVs、mVe/mVa能更全面评估急诊PCI术后心功能不全的发生，对识别有可能发生心功能不全高危患者以及早期给予干预措施具有一定意义。

Objective: To explore the predictive value of NT-proBNP, neutrophil to lymphocyte ratio and quantitative tissue velocity imaging in cardiac dysfunction of patients with acute ST segment elevation myocardial infarction undergoing primary PCI. Methods: A total of 132 patients with STEMI who underwent primary PCI were enrolled in the study.The levels of NT-proBNP and NLR were measured before primary PCI. The corresponding segmental left ventricular wall motion velocity of diseased vessel was measured by quantitative tissue velocity imaging.The indexes including systolic peak elocity (Vs), early diastolic peak velocity (Ve), late diastolic peak velocity (Va) and Ve/Va were tested. Then we calculated out the mean systolic peak elocity (mVs), mean early diastolic peak velocity (mVe), mean late diastolic peak velocity (mVa) and mVe/mVa.The occurrence of cardiac dysfunction was followed up during 30 days after PCI. According to wheater cardiac dysfunction happened during 30-day follow up, the patients were divided into cardiac dysfunction group (n=27) and non-cardiac dysfunction group (n=105). NT-proBNP, NRL, Vs, mVe, mVa and mVe/mVa were compared between the two groups. Results: Compared with non -cardiac dysfunction group, the levels of NT-proBNP, NRL were significantly higher in cardiac dysfunction group(1 369.53±293.23 vs 346.18±39.9 pg·ml^-1,P < 0.01;8.24 ±0.42 vs 5.49±0.25,P < 0.05),but mVs, mVe/mVa were significantly lower in cardiac dysfunction group(3.16±1.21 vs 5.64±1.48 cm·s^-1,0.96±0.47 vs 1.88±0.76,P < 0.05). Correlation analysis indicated that NT-proBNP was positively correlated with NLR(r=0.264,P < 0.01),both NT-proBNP and NLR were negatively correlated with mVs and mVe/mVa(r=-0.399,P < 0.05; r=-0.146,P < 0.05; r=-0.401,P < 0.01; r=-0.584,P < 0.05). Multivariate logistic regression analysis showed that NT-proBNP>1 000 pg·ml^-1 (P=0.014,OR=1.738,95%CI: 1.088~9.543), NLR>6.85(P=0.021,OR=2.104,95%CI: 1.274~10.652), mVs<4.5 cm·s^-1 (P=0.018,OR=1.886,95%CI: 1.030~5.747) were the independent risk factors of cardiac dysfunction. Conclusion: Intergrated application of NT-proBNP, NLR, mVs and mVe/mVa may be more comprehensive and accurate in predicting the occurrence of cardiac dysfunction after primary PCI. It is of significance to identify patients with high risk of heart failure and give early intervention.

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