>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
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
作者:李勇  李占虎  闫小菊  郭丽娟  李凤德 
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-1P<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-1P=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-1P=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.

参考文献:

[1] LIMALANATHAN S,ANDERSEN G,KLOW N E,et al.Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated by primary PCI results of the POSTEMI (Postconditioning in ST-elevation myocardial infarction) randomized trial[J].J Am Heart Assoc,2014,3(2):e000679.
[2] SANKARA C S,RAJASEKHAR D,VANAJAKSHAMMA V,et al.Prognostic significance of NT-proBNP,3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary percutaneous intervention[J].Indian Heart J,2015,67(4):318-327.
[3] RADWAN H,SELEM A,GHAZAL K.Value of N-terminal pro brain natriuretic peptide in predicting prognosis and severity of coronary bartery disease in acute coronary syndrome[J].J Saudi Heart Assoc,2014,26(4):192-198.
[4] DREWNIAK W,SZYBKA W,BIELECKI D,et al. Prognostic significance of NT-proBNP levels in patients over 65 presenting acute myocardial infarction treated invasively or conservatively[J].Biomed Res Int,2015,2015:782026.
[5] KURTUL A,NAMIK S N,YARLIOGLUES M,et al.Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Clinics (Sao Paulo),2015,70(1):34-40.
[6] KURTUL A,MURAT S N,YARLIOGLUES M,et al. The relationship between neutrophil/lymphocyte ratio and infarctrelated artery patency before mechanical reperfusion in patients with STelevation myocardial infarction[J].Coron Artery Dis,2014,25(2):159-166.
[7] PARK J J,JANG H J,Oh I Y,et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with STelevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Am J Cardiol,2013,111(5):636-642.
[8] AKPEK M,KAVA M G,LAM Y Y,et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention[J].Am J Cardiol,2012,110(5):621-627.
[9] NILSSON L,WIERINGA W G,PUNDZIUTE G,et al. Neutrophil/lymphocyte ratio is associated with non-calcified plaque burden in patients with coronary artery disese[J].Plos One,2014,9(9):e108183.
[10] BOREKCI A,GUR M,TURKOGLU C,et al. Neutrophil to lymphocyte ratio predicts left ventricular remodeling in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention[J].Korean Circ J,2016,46(1):15-22.
[11] ARBEL Y,SHACHAM Y,ZIV-BARAN T,et al. Higher neutrophil/lymphocyte ratio is related to lower ejection fraction and higher long term all-cause mortality in STEMI patients undergoing primary PCI[J].Can J Cardiol,2014,30(10):1177-1182.
[12] WESTHOLM C,JOHNSON J,SAHLEN A,et al.Peak systolic velocity using color-coded tissue Doppler imaging,a strong and independent predictor of outcome in acute coronary syndrome patients[J].Cardiovasc Ultrasound,2013,11(1):1-8.
[13] KAVA M G,AKPEK M,LAM Y Y,et al.Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention:a prospective,multicenter study[J].Int J Cardiol,2013,168(2):1154-1159.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 233104 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364