南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (01): 112-.

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急性心肌梗死早期脑钠肽浓度的动态演变规律及其对心力衰竭的诊断价值

李慧娣，向定成，张金霞，段天兵，龙锋，李爱敏   

  • 出版日期:2018-01-20 发布日期:2018-01-20

Dynamic changes of brain natriuretic peptide concentration and its diagnostic value for heart failure in early phase of acute myocardial infarction

  • Online:2018-01-20 Published:2018-01-20

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摘要： 目的探讨急性心肌梗死（AMI）早期脑钠肽（BNP）浓度的动态演变规律及各个时间点BNP浓度对当时心力衰竭的诊断价 值。方法以2016年1月1日~2016年7月31日就诊于广州军区广州总医院心内科并于发病12 h内行急诊经皮冠脉介入治疗术 （PCI）的AMI患者为研究对象，床边检测术后1 h内、发病12、20、24和48 h静脉血BNP浓度，并记录各时间点的心功能诊断，按 照48 h内BNP峰值浓度是否大于400 pg/mL分为BNP峰值升高组（>400 pg/mL）和BNP峰值大致正常组（≤400 pg/mL）。结果 本研究共入选70例患者，发病48 h内BNP呈现先上升后下降的单峰趋势，Friedman M检验提示5个时间点的BNP浓度差异有 统计学意义（χ2=141.7，P<0.05），两两比较结果显示发病20 h和发病24 h的BNP浓度差异无统计学意义（χ2=0.173，P>0.05），而 其他时间点两两比较均可见统计学差异（P<0.05），达峰时间为发病20~24 h。与BNP峰值大致正常组（n=47）相比，BNP峰值升 高组（n=23）的年龄大、体质量指数小、再灌注时间长、前壁心肌梗死比例及住院期间并发肺部感染的比例高，差异均有统计学意 义（P<0.05）。二分类逻辑回归显示，年龄、体质量指数和前壁心肌梗死与BNP峰值浓度升高独立相关。ROC曲线分析提示，术 后1 h内的BNP浓度对心力衰竭发生与否无诊断作用（P>0.05），发病12、20、24、48 h的BNP对心衰有诊断价值（P<0.05），曲线 下面积分别为0.860、0.786、0.768和0.863，最佳分界值分别为156.5、313.7、240.9和285.9 pg/mL。结论AMI早期BNP呈先升 高后下降的单峰趋势，并于发病20~24 h达到峰值，发病后不同时间点BNP对当时心衰的诊断价值存在差异。

Abstract: Objective To explore the dynamic changes in brain natriuretic peptide (BNP) concentration and the diagnostic value of BNP for heart failure at different time points in the early phase of acute myocardial infarction (AMI). Methods AMI patients who were admitted in our department between January 1, 2016 and July 31, 2016 and underwent emergency percutaneous coronary intervention (PCI) within 12 h after onset were enrolled in this study. All the patients received bedside examinations of BNP concentration and clinical cardiac function within 1 h after PCI and at 12, 20, 24 and 48 h after the onset of AMI. According to the peak BNP concentration, the patients were divided into high peak BNP group (>400 pg/mL) and normal peak BNP group (≤400 pg/mL). Results Seventy patients were enrolled in the study. Within 48 h after AMI onset, BNP concentration variations followed a pattern of an initial increase till reaching the peak concentration at 20 to 24 h, with subsequent gradual decrease. BNP concentrations differed significantly among the indicated time points (χ2=141.7, P<0.05) except for those between 20 h and 24 h (χ2=0.173, P>0.05). Compared with those in normal peak BNP group, the patients in high peak BNP group had an older age, a lower BMI, a longer time to perfusion, and a higher likeliness of anterior myocardial infarction and pulmonary infection (P<0.05). Logistic regression analysis showed that age, BMI and anterior myocardial infarction were independently associated with the increase of peak BNP concentration. ROC curve analysis showed that BNP concentration within 1 h after emergency PCI was unable to diagnose heart failure at that time (P>0.05), while BNP concentrations at 12, 20, 24 and 48 h after AMI onset had significant diagnostic values for heart failure (P<0.05) with areas under ROC of 0.860, 0.786, 0.768 and 0.863, and optimal cutoff values of 156.5, 313.7, 240.9 and 285.9 pg/mL, respectively. Conclusions BNP concentration increases first and then decreases in the early phase of AMI, and the peak concentration occurs at 20-24 h after the onset. The diagnostic values of BNP concentrations at different time points also vary.