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王筱.N末端B型脑钠肽原、超敏-C反应蛋白、D-二聚体、降钙素原联合检测可提高急性心肌梗死后心力衰竭的预测效能[J].内科急危重症杂志,2025,31(6):540-544
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| DOI：10.11768/nkjwzzzz20250611 |
| 中文关键词: 受试者工作特征曲线 决策曲线 N末端前B型脑钠肽原 超敏-C反应蛋白 D-二聚体 降钙素原 急性心肌梗死 心力衰竭 |
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| 摘要点击次数: 6 |
| 全文下载次数: 7 |
| 中文摘要: |
| 摘要 目的：探讨N末端B型脑钠肽原（NT-proBNP）、超敏-C反应蛋白（hs-CRP）、D-二聚体（D-D）、降钙素原（PCT）预测急性心肌梗死后并发心力衰竭的评估价值。方法：选取111例急性心肌梗死患者，根据是否合并心力衰竭分为合并组（39例）与未合并组（72例）。检测2组血清NT-proBNP、hs-CRP、D-D、PCT水平及心功能指标 [包括左心室射血分数（LVEF）、左心房前后径（LAD）、左心室舒张末期内径（LVEDD）]。采用Pearson相关性分析各指标与心功能的关系，Logistic回归分析并发症的影响因素，采用受试者工作特征（ROC）曲线分析各指标单独及联合检测的预测效能 [计算曲线下面积（AUC）]，决策曲线（DCA）分析其临床净获益。结果：与未合并组比较，合并组患者血清NT-proBNP、hs-CRP、D-D、PCT、LAD及LVEDD水平升高；LVEF水平降低（P均<0.05）。经Logistic多因素分析，NT-proBNP、hs-CRP、D-D、PCT、LAD、LVEDD为影响急性心肌梗死后并发心力衰竭的危险因素，而LVEF是其保护因素（P均<0.05）。经ROC曲线分析，NT-proBNP、hs-CRP、D-D、PCT单独及联合检测的AUC分别为0.820、0.846、0.660、0.774、0.929。DCA结果显示，NT-proBNP、hs-CRP、D-D、PCT单独及联合检测对预测急性心肌梗死后并发心力衰竭具有较好的净获益，且联合检测净获益更高。结论：血清 NT-proBNP、hs-CRP、D-D 及 PCT 水平升高是急性心肌梗死后并发心力衰竭的重要提示，四项指标联合检测具有更高的预测价值。 |
| 英文摘要: |
| Abstract Objective: To analyze the performance and clinical utility of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), D- dimer (D-D) and procalcitonin (PCT) in predicting heart failure after acute myocardial infarction. Methods: Totally, 111 patients with acute myocardial infarction in our hospital were divided into combined group (39 cases) and non-combined group (72 cases) according to whether they were complicated with heart failure or not. Serum NT-proBNP, hs-CRP, D-D, PCT levels and cardiac function indexes [left ventricular ejection fraction (LVEF), left atrial anteroposterior diameter (LAD), left ventricular end diastolic diameter (LVEDD)] were detected in the two groups. Pearson correlation analysis was used to analyze the relationship between indexes and cardiac function. Logistic regression analysis was used to analyze the influencing factors of complications. Receiver operating characteristic (ROC) curve was used to analyze the predictive performance of individual and combined detection of each index [calculating the area under the curve (AUC)], and decision curve analysis(DCA) curve was used to analyze its clinical net benefit. Results: As compared with the non-combined group, the serum levels of NT-proBNP, hs-CRP, D-D, PCT, LAD and LVEDD in the combined group were significantly increased, and LVEF level decreased significantly (all P< 0.05). Logistic multivariate analysis showed that NT-proBNP, hs-CRP, D-D, PCT, LAD and LVEDD were the risk factors of heart failure after acute myocardial infarction, and LVEF was the protective factor (all P<0.05). According to the analysis of ROC curve, the AUC of NT-proBNP, hs-CRP, D-D and PCT was 0.820, 0.846, 0.660, 0.774 and 0.929, respectively. DCA analysis revealed that the single detection and combined detection of NT-proBNP, hs-CRP, D-D, PCT had a good net benefit in predicting heart failure after acute myocardial infarction, and the net benefit of combined detection was higher. Conclusion: Elevated serum levels of NT-proBNP, hs-CRP, D-D and PCT are important indications of heart failure after acute myocardial infarction. Combined detection of the four indexes has higher predictive value and clinical practical value for this complication, which is better than single detection. |
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