摘要/Abstract

摘要： 目的 ·探讨急性心肌梗死（ acute myocardial infarction，AMI）后预测左心室重构 (left ventricular remodeling，LVR)的相关生物标志物。方法 ·连续纳入 2015年 1月 1日至 2016年 1月 1日上海交通大学附属第六人民医院心脏中心收治的 AMI并成功接受急诊经皮冠状动脉介入治疗（排除右冠状动脉相关 AMI）的患者 220例，采集入院和 AMI后 1年的超声心动图，定义 AMI后 1年左心室舒张末期容积（ left ventricular end diastolic volume，LVEDV）较入院时增加大于 20%为 LVR。将 AMI患者分为 LVR组与 nonLVR组，比较 2组患者在院的心肌损伤标志物及炎症因子间的差别，分析其与 LVR的相关性。结果 ·与 non-LVR组相比， LVR组患者入院即刻及峰值血清肌钙蛋白 I(serum cardiac troponin I，cTnI)、MB型磷酸肌酸（creatine kinase MB，CKMB）、肌红蛋白、中性粒细胞与单核细胞比值、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）均显著升高（均 P<0.05），但是 2组间脑钠肽前体（brain natriuretic peptide precursor，proBNP）和脑钠肽（brain natriuretic peptide，BNP）水平的差异无统计学意义。Logistic回归分析显示即刻 cTnI及 NLR与 LVR显著相关。 ROC曲线显示入院即刻 cTnI曲线下面积（ AUC）为 0.704，截断点为 9.14 μg/L时，预测 LVR的灵敏度和特异度分别为 69.2%和 64.3%；NLR的 AUC为 0.664，截断点为 5.87%时，预测 LVR的灵敏度和特异度分别为 70.6%和 60.2%。结论 · AMI患者入院时血清即刻 cTnI及 NLR水平升高是预测 LVR的独立因子，具有较好的诊断价值。
关键词: 急性心肌梗死, 左心室重构, 生物标志物, 超声心动图
Abstract:
Objective · To investigate the correlation between the biomarkers and left ventricular remodeling (LVR) in patients after acute myocardial infarction (AMI). Methods · 220 patients with AMI who were admitted in the Department of Cardiology of the Shanghai Sixth Peoples Hospital January 1st, 2015 to January 1st, 2016 and received successful primary percutaneous coronary intervention were included in this study sequentially. AMI patients due to right coronary artery were excluded. LVR after AMI was defined as more than 20% increase of the left ventricular end diastolic volume (LVEDV) measuredechocardiogram in 1-year-follow-up compared with LVEDV at admission. Patients were divided into LVR group and non-LVR group. The differences of myocardial injury markers and inflammatory factors between the two groups were compared, and the correlation between LVR and the biomarkers was analyzed. Results · Compared with the non-LVR group, the cTnI (serum cardiac troponin I), CKMB (creatine kinase MB) and myoglobin levels at admission and peaks, as well as neutrophil to monocyte ratio and neutrophil to lymphocyte ratio (NLR) in the LVR group were increased significantly (all P<0.05). There was no significant difference in proBNP (brain natriuretic peptide precursor) and BNP levels between the two groups. Logistic regression analysis showed that cTnI and NLR at admission were correlated well with LVR. ROC curve analysis showed that the area under the cTnIadmission curve (AUC) was 0.704, and the sensitivity and specificity of cTnIadmission to predict LVR after AMI were 69.2% and 64.3% respectively, when 9.14 μg/L was chosen as the cut-off point. The area under the NLR curve (AUC) was 0.664, and the sensitivity and specificity of NLR were 70.6% and 60.2% respectively, when 5.87% was chosen as the cut-off point. Conclusion · The increased levels of cTnI and NLR at admission in patients with AMI are independent predictors of LVR.
Key words: acute myocardial infarction, left ventricular remodeling, biomarker, echocardiography


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