CAJ | 학술논문

目的探讨急性心肌梗死患者入院N末端B型利钠肽原(NT-proBNP)水平与急诊经皮冠状动脉(简称冠脉)介入治疗术后无复流现象的关系.方法入选接受急诊PCI治疗的急性心肌梗死患者106例.检测入院时NT-proBNP以及肌钙蛋白Ⅰ、超敏C反应蛋白等生物标志物.依据入院时NT-proBNP水平将患者分为NT-proBNP正常组(≤400 ng/L)和NT-proBNP升高组(＞400 ng/L).根据冠脉造影血流TIMI分级,将患者分为冠脉血流正常组(TIMI分级=3)和无复流组(TIMI分级≤2).比较两组间各项生物标志物以及临床特征的差异.以ROC曲线计算NT-proBNP预测无复流发生的阈值,采用多因素Logistic回归分析急诊PCI术后无复流发生的危险因素.结果 NT-proBNP升高组患者中无复流的发生率明显高于NT-proBNP正常组(16.6％比3.6％,P＜0.05).无复流组患者入院NT-proBNP水平明显高于冠脉血流正常组[1883 ng/L(484 ～ 5500 ng/L)比220 ng/L(87 ～926 ng/L)P =0.046].入院NT-proBNP＞ 1765 ng/L是急性心肌梗死PCI术后冠脉造影无复流的独立危险因素(OR=10.3,95％ CI 1.49～ 70.65,P =0.018),其预测急诊PCI术后冠脉造影无复流的敏感度为60.0％,特异度为87.5％.结论入院时NT-proBNP水平作为一项生物学标志物可能具有预测和协助诊断急诊PCI术后冠脉造影无复流发生的价值.
목적 탐토급성심기경사환자입원N말단B형리납태원(NT-proBNP)수평여급진경피관상동맥(간칭관맥)개입치료술후무복류현상적관계.방법 입선접수급진PCI치료적급성심기경사환자106례.검측입원시NT-proBNP이급기개단백Ⅰ、초민C반응단백등생물표지물.의거입원시NT-proBNP수평장환자분위NT-proBNP정상조(≤400 ng/L)화NT-proBNP승고조(＞400 ng/L).근거관맥조영혈류TIMI분급,장환자분위관맥혈류정상조(TIMI분급=3)화무복류조(TIMI분급≤2).비교량조간각항생물표지물이급림상특정적차이.이ROC곡선계산NT-proBNP예측무복류발생적역치,채용다인소Logistic회귀분석급진PCI술후무복류발생적위험인소.결과 NT-proBNP승고조환자중무복류적발생솔명현고우NT-proBNP정상조(16.6％비3.6％,P＜0.05).무복류조환자입원NT-proBNP수평명현고우관맥혈류정상조[1883 ng/L(484 ～ 5500 ng/L)비220 ng/L(87 ～926 ng/L)P =0.046].입원NT-proBNP＞ 1765 ng/L시급성심기경사PCI술후관맥조영무복류적독립위험인소(OR=10.3,95％ CI 1.49～ 70.65,P =0.018),기예측급진PCI술후관맥조영무복류적민감도위60.0％,특이도위87.5％.결론 입원시NT-proBNP수평작위일항생물학표지물가능구유예측화협조진단급진PCI술후관맥조영무복류발생적개치.
Objective To determine the relationship between N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and angiographic no-reflow phenomenon in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI).Methods The data of 106 consecutive AMI patients undergoing primary PCI were collected and analyzed retrospectively.NT-proBNP was obtained pre-PCI at admission.According to the NT-proBNP level,they were divided into normal and elevated NT-proBNP groups.The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infaretion (TIMI) grade ＜3 without accompanying mechanical factors.Results The patients with elevated NT-proBNP on admission had a higher incidence of no-reflow phenomenon than those with NT-proBNP level.Compared to normal reflow counterparts,no-reflow patients had a higher NT-proBNP level [1883 ng/L(484 ～ 5500 ng/L) vs 220 ng/L(87 ～ 926 ng/L) P =0.046].Multivariate analysis showed that a high NT-proBNP level (NT-proBNP ＞ 1765 ng/L) on admission was an independent predictor of no-reflow.This cut-off value yielded a sensitivity of 60.0％ and a specificity of 87.5％ respectively.ConcIusion The NT-proBNP level on admission may be a prognostic biomarker in the prediction of the development of angiographic "no-reflow" phenomenon after primary PCI for AMI patients.