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目的观察AMI患者发病第3天血清NT-proBNP水平与其左室重构之间的关系,评价其对AMI后左室重构的预测价值。方法以急性心肌梗死(AMI)发病第3天与3个月时患者的左心室舒张末期内径之差(△LVDd)>5 mm以及发病3个月时左心室射血分数(LVEF)≤40％作为发生心脏左室重构的依据。采用免疫电化学发光法测定106例患前壁、前间壁及前侧壁AMI的患者第3天血清NT-proBNP水平,分别对患者第3天和3个月时行超声心动描述术检测LVDd和LVEF水平。结果AMI患者第3天血清NT-proBNP均值是1039．28(241．50～1184．25)ng／L。AMI患者第3天和3个月时LVDd由(50±5)mm升至(53±7)mm(P<0．05),LVEF由(53±8)％升高为(54±11)％(P>0．05)。AMI后第3天NT-proBNP浓度与△LVDd呈显著正相关r=0．403(P<0．05),与LVEF呈显著负相关r=-0．395(P<0．01);ROC曲线分析表明以AMI发病3个月间△LVDd>5 mm作为发生左室重构的依据,曲线下面积(AUC)为0．894;以AMI发病3个月时LVEF≤40％作为发生左室重构的依据,则AUC为0．873;以AMI发病3个月间ALVDd>5 mm和3个月时LVEF≤40％作为发生左室重构的依据,则AUC为0．893。结论AMI患者第3天血清NT-proBNP水平可作为预测AMI晚期的左室重构指标之一。
Objective To observe the relationship between serum NT-proBNP levels and left ventricular remodeling on the third day after onset of AMI in order to evaluate the predictive value of left ventricular remodeling after AMI. Methods The left ventricular end-diastolic diameter (△ LVDd)> 5 mm at 3 and 3 months after onset of acute myocardial infarction (AMI) and the left ventricular ejection fraction (LVEF) ≤40% As a basis for the occurrence of cardiac remodeling in the left ventricle. Immuno-chemiluminescence was used to determine the level of serum NT-proBNP on the third day in 106 patients with anterior wall, anteroseptal and anterior wall AMI. Echocardiography was used to detect the level of NT-proBNP at day 3 and 3 respectively. LVEF level. Results The mean serum NT-proBNP in AMI patients was 1039.28 (241.50 ~ 1184.25) ng / L on the third day. LVDd increased from (50 ± 5) mm to (53 ± 7) mm (P <0.05) at 3 days and 3 months in AMI patients, and increased from (53 ± 8)% to (54 ± 11) % (P> 0.05). There was a significant positive correlation between NT-proBNP concentration and △ LVDd on the third day after AMI (r = 0.403, P <0.05), and a significant negative correlation with LVEF (r = -0.395, P <0.01) Curvilinear analysis showed that the area under the curve (AUC) was 0.894 with △ LVDd> 5 mm as the incidence of AMI during 3 months after onset of AMI. When LVEF≤40% at 3 months after onset of AMI, According to the reconstruction, the AUC was 0.873. The AUC was 0.893 when the ALVDd> 5 mm at 3 months of AMI and LVEF≤40% at 3 months were used as the basis for left ventricular remodeling. Conclusion The level of serum NT-proBNP on the third day of AMI can be used as one of the indicators to predict the late stage of left ventricular remodeling.