急性心肌梗死及心力衰竭患者NT-proBNP、Myo和cTnT的水平变化及诊断价值
|
摘要
目的探讨急性心肌梗死及心力衰竭患者的血清氨基末端B型钠尿肽原(NT-proBNP)、肌红蛋白(Myo)和心肌肌钙蛋白T(cTnT)的水平变化及诊断价值。方法选择2015年3月至2017年8月收治的急性心肌梗死及心力衰竭患者50例为观察组。其中,心肌梗死患者32例,心力衰竭患者18例。所有患者给予肝素、阿司匹林、氯匹格雷等药物治疗,同时限制钠水摄入,给予患者利尿药、β受体阻滞药,根据治疗预后分为预后良好组和预后较差组。选择同期入院健康体检者50例为观察组。采用罗氏Elecsys2010全自动电化学发光免疫分析仪测定各组NTpro BNP、Myo及cTnT水平,对NT-proBNP、Myo及cTnT诊断效能绘制ROC曲线,与标准曲线进行比较获得敏感性、特异性参数进行评估。结果观察组NT-proBNP、Myo及cTnT水平,均高于对照组(P <0. 05);观察组中急性心肌梗死和心力衰竭患者NT-proBNP、Myo及cTnT水平比较无统计学意义(P> 0. 05); 50例急性心肌梗死及心力衰竭患者均顺利完成治疗,治疗后41例治疗预后良好,9例患者治疗预后较差。治疗预后良好组NT-proBNP、Myo及cTnT水平,均低于预后较差组(P <0. 05)。单项检测NT-proBNP、Myo、cTnT在急性心肌梗死及心力衰竭患者诊断特异性和特异性较P53蛋白高(P> 0. 05);联合检测NT-proBNP、Myo、cTnT诊断急性心肌梗死及心力衰竭敏感性、特异性高于单一检测(AUC 0. 931,P <0. 05)。结论将NT-proBNP、Myo及cTnT水平用于急性心肌梗死及心力衰竭患者诊断中效果理想,能获得较高的诊断效能,有助于指导临床治疗,值得推广应用。
Objective To investigate the changes of NT proBNP,Myo and cTnT of the patients with acute myocardial infarction and heart failure and their diagnostic value. Methods Fifty patients with acute myocardial infarction and heart failure including 32 cases of acute myocardial infarction and 18 cases of heart failure,who were admitted and treated in our hospital from March 2015 to August 2017,were enrolled as observation group. All the patients in observation group were treated by heparin,aspirin,clopidogrel,diuretics and β blockers. Na+and water were limited during the course. Then the patients were divided into good prognosis group and poor prognosis group according to patient's prognosis. Meanwhile,fifty healthy subjects who underwent physical examination in our hospital were enrolled as control group. Elecsys 2010 was used to measure the levels of NT-proBNP,Myo and cTnT in each group. The ROC curves of NT-proBNP,Myo and cTnT were drawn and compared with the standard curve to obtain the sensitivity and specificity parameters for evaluation. Results The levels of NT-proBNP,Myo and cTnT in observation group were significantly higher than those in control group( P < 0. 05). There were no significant differences in the levels of NT-proBNP,Myo and cTnT between the patients with acute myocardial infarction and the patients with heart failure( P > 0. 05). All the patients were treated. The 41 patients had good prognosis and 9 patients had poor prognosis. The levels of NT-proBNP,Myo and cTnT in the patients with good prognosis were significantly lower than those in patients with poor prognosis( P < 0. 05). The diagnostic specificity and specificity of NT-proBNP,Myo and cTnT of the patients with acute myocardial infarction and heart failure were relatively higher than those of P53 protein( P > 0. 05). The combination detection of NT-proBNP,Myo and cTnT was more sensitive than single detection in diagnosis of acute myocardial infarction and heart failure( AUC 0. 931,P < 0. 05). Conclusion The levels of NT-proBNP,Myo and cTnT are quite helpful in diagnosis of acute myocardial infarction and heart failure,which can improve diagnostic efficiency,guide clinical treatment.Therefore,it is worthy of popularization.
Objective To investigate the changes of NT proBNP,Myo and cTnT of the patients with acute myocardial infarction and heart failure and their diagnostic value. Methods Fifty patients with acute myocardial infarction and heart failure including 32 cases of acute myocardial infarction and 18 cases of heart failure,who were admitted and treated in our hospital from March 2015 to August 2017,were enrolled as observation group. All the patients in observation group were treated by heparin,aspirin,clopidogrel,diuretics and β blockers. Na+and water were limited during the course. Then the patients were divided into good prognosis group and poor prognosis group according to patient's prognosis. Meanwhile,fifty healthy subjects who underwent physical examination in our hospital were enrolled as control group. Elecsys 2010 was used to measure the levels of NT-proBNP,Myo and cTnT in each group. The ROC curves of NT-proBNP,Myo and cTnT were drawn and compared with the standard curve to obtain the sensitivity and specificity parameters for evaluation. Results The levels of NT-proBNP,Myo and cTnT in observation group were significantly higher than those in control group( P < 0. 05). There were no significant differences in the levels of NT-proBNP,Myo and cTnT between the patients with acute myocardial infarction and the patients with heart failure( P > 0. 05). All the patients were treated. The 41 patients had good prognosis and 9 patients had poor prognosis. The levels of NT-proBNP,Myo and cTnT in the patients with good prognosis were significantly lower than those in patients with poor prognosis( P < 0. 05). The diagnostic specificity and specificity of NT-proBNP,Myo and cTnT of the patients with acute myocardial infarction and heart failure were relatively higher than those of P53 protein( P > 0. 05). The combination detection of NT-proBNP,Myo and cTnT was more sensitive than single detection in diagnosis of acute myocardial infarction and heart failure( AUC 0. 931,P < 0. 05). Conclusion The levels of NT-proBNP,Myo and cTnT are quite helpful in diagnosis of acute myocardial infarction and heart failure,which can improve diagnostic efficiency,guide clinical treatment.Therefore,it is worthy of popularization.
引文
1贾红丹.左西孟旦对老年急性心肌梗死合并心衰患者NT-proBNP和炎症水平的影响.中国老年学杂志,2016,36:4469-4470.
2林绍侠,刘志兵,蔡铁海,等.血清s ST2联合NT-proBNP检测对心力衰竭患者预后的预测价值.山东医药,2016,56:61-62.
3 Dondo TB,Hall M,West RM,et al.β-Blockers and mortality after acute myocardial infarction in patients sithout heart failure or ventricular dysfunction.Journal of the American College of Cardiology,2017,69:2710.
4曹丽,安冬梅,石磊,等.急性心肌梗死患者经皮冠状动脉支架植入术术后血清so L-CXCL16及NT-proBNP水平变化分析.重庆医学,2017,46:1036-1037.
5柳彩侠,卜林,孙东.慢性心肾综合征患者外周血Tn I、NT-proBNP、H-FABP及MYO水平观察.山东医药,2017,57:27-30.
6赵艳军,王华荣,李富利,等.联合LVEF和NT-proBNP检测在症状不典型非ST抬高性急性冠脉综合征早期预后评估中的作用.实用医学杂志,2017,33:2311-2315.
7 Rigolli M,Rossi A,Quintana M,et al.The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction:Can age-stratified E/A ratio alone predict survival.International Journal of Cardiology,2015,181:362.
8陈晓迎,张丹,谢明,等.嗜铬粒蛋白A与脓毒症心肌损伤标志物的相关性分析.中国急救医学,2016,36:495-498.
9汤子鸣,秦俭.急性心力衰竭患者联合检测血清糖类抗原CA125和N末端脑钠肽原的临床意义.中国现代医学杂志,2016,26:51-53.
10张荣成,张宇辉,张健,等.血浆三种标志物变化在晚期心力衰竭患者心血管事件预测中的初步分析.中国循环杂志,2015,30:428-432.
11傅永平,周玥.和肽素和NT-proBNP联合检测在慢性心力衰竭患者病情分级中的应用.中华急诊医学杂志,2016,25:509-511.
12 Skoric L J,Obrenovic-Kircanski B,Matic M.Influence of heart failure on survival in patients with acute myocardial infarction and diabetes mellitus:7 years follow-up.European Journal of Heart Failure,2015,2:64.
13姚光辉.高龄急性心力衰竭患者入院早期中性粒细胞/淋巴细胞比值与近期心血管不良事件的相关性研究.中国急救医学,2015,35;35:437-441.
14邹宁,庞晓,曹慧.慢性心力衰竭合并肾损害患者血清白细胞介素1、白细胞介素6水平的变化及临床意义.中国动脉硬化杂志,2017,25:710-714.
15胡振,张新超,张堃,等.血清可溶性ST2评价老年急性心力衰竭患者病情与预后的研究.中华急诊医学杂志,2016,25:1035-1040.
2林绍侠,刘志兵,蔡铁海,等.血清s ST2联合NT-proBNP检测对心力衰竭患者预后的预测价值.山东医药,2016,56:61-62.
3 Dondo TB,Hall M,West RM,et al.β-Blockers and mortality after acute myocardial infarction in patients sithout heart failure or ventricular dysfunction.Journal of the American College of Cardiology,2017,69:2710.
4曹丽,安冬梅,石磊,等.急性心肌梗死患者经皮冠状动脉支架植入术术后血清so L-CXCL16及NT-proBNP水平变化分析.重庆医学,2017,46:1036-1037.
5柳彩侠,卜林,孙东.慢性心肾综合征患者外周血Tn I、NT-proBNP、H-FABP及MYO水平观察.山东医药,2017,57:27-30.
6赵艳军,王华荣,李富利,等.联合LVEF和NT-proBNP检测在症状不典型非ST抬高性急性冠脉综合征早期预后评估中的作用.实用医学杂志,2017,33:2311-2315.
7 Rigolli M,Rossi A,Quintana M,et al.The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction:Can age-stratified E/A ratio alone predict survival.International Journal of Cardiology,2015,181:362.
8陈晓迎,张丹,谢明,等.嗜铬粒蛋白A与脓毒症心肌损伤标志物的相关性分析.中国急救医学,2016,36:495-498.
9汤子鸣,秦俭.急性心力衰竭患者联合检测血清糖类抗原CA125和N末端脑钠肽原的临床意义.中国现代医学杂志,2016,26:51-53.
10张荣成,张宇辉,张健,等.血浆三种标志物变化在晚期心力衰竭患者心血管事件预测中的初步分析.中国循环杂志,2015,30:428-432.
11傅永平,周玥.和肽素和NT-proBNP联合检测在慢性心力衰竭患者病情分级中的应用.中华急诊医学杂志,2016,25:509-511.
12 Skoric L J,Obrenovic-Kircanski B,Matic M.Influence of heart failure on survival in patients with acute myocardial infarction and diabetes mellitus:7 years follow-up.European Journal of Heart Failure,2015,2:64.
13姚光辉.高龄急性心力衰竭患者入院早期中性粒细胞/淋巴细胞比值与近期心血管不良事件的相关性研究.中国急救医学,2015,35;35:437-441.
14邹宁,庞晓,曹慧.慢性心力衰竭合并肾损害患者血清白细胞介素1、白细胞介素6水平的变化及临床意义.中国动脉硬化杂志,2017,25:710-714.
15胡振,张新超,张堃,等.血清可溶性ST2评价老年急性心力衰竭患者病情与预后的研究.中华急诊医学杂志,2016,25:1035-1040.