作者：吴媛媛1 ，陈莉 1 ，李翠翠 1 ，王方明 2 ，王云武 ３

单位：

1.271199 山东省济南市人民医院保健科　；2.271199 山东省济南市人民医院心内科　；3.250031 山东省济南市第四人民医院心内科；通信作者：吴媛媛，E-mail：apricot1111@163.com

Units：

1.Department of Health Care，Ji'nan City People's Hospital，Ji'nan 271199，China；2.Department of Cardiology，Ji'nan City People's Hospital，Ji'nan 271199，China；3.Department of Cardiology，the Fourth People's Hospital of Ji'nan，Ji'nan 250031，China；Corresponding author：WU Yuanyuan，E-mail：apricot1111@163.com

关键词：

心肌梗死；心力衰竭；促生长激素释放多肽；脑钠肽；影响因素分析；预测价值

Keywords：

Myocardial infarction；Heart failure；Ghrelin；BNP；Root cause analysis；Predictive value

CLC：

R 542.22　R 541.6

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.009

Funds：

基金项目：2016 年度山东省重点研发计划（第一批）拟立项项目（2016ZRA01076）

摘要：

背景　心力衰竭是导致急性心肌梗死（AMI）患者预后不良的主要原因，而早期识别心力衰竭高危人群并优化个体化治疗方案是目前临床研究的热点和难点之一。目的　探讨血浆促生长激素释放多肽（Ghrelin）、脑钠肽（BNP）水平与 AMI 患者心力衰竭的关系。方法　选取 2016 年 1 月—2018 年 1 月济南市人民医院和济南市第四人民医院收治的 AMI 患者 108 例，根据随访 12 个月期间心力衰竭发生情况分为心力衰竭组 18 例和无心力衰竭组 90例。比较两组患者临床特征及血浆 Ghrelin、BNP 水平；AMI 患者心力衰竭的影响因素分析采用多因素 Logistic 回归分析；绘制 ROC 曲线以评价血浆 Ghrelin、BNP 水平及二者联合对 AMI 患者心力衰竭的预测价值。结果　（1）本研究中 AMI 患者心力衰竭发生率为 16.67%（18/108）。心力衰竭组患者中行急诊经皮冠状动脉介入治疗（PCI）者所占比例、血浆 Ghrelin 水平低于无心力衰竭组，冠状动脉病变支数多于无心力衰竭组，血浆 BNP 水平高于无心力衰竭组（P<0.05），且两组患者经皮冠状动脉介入治疗类型、冠状动脉病变位置比较，差异有统计学意义（P<0.05）；两组患者男性比例、年龄、吸烟率、糖尿病发生率、高血压发生率、ST 段抬高型患者所占比例、全球急性冠状动脉事件注册（GRACE）评分、Gensini 评分比较，差异无统计学意义（P>0.05）。（2）多因素 Logistic 回归分析结果显示，冠状动脉病变支数〔OR=1.397，95%CI（1.204，1.622）〕及血浆 Ghrelin〔OR=1.278，95%CI（1.105，1.477）〕、BNP〔OR=1.478，95%CI（1.328，1.643）〕水平是 AMI 患者心力衰竭的独立影响因素（P<0.05）。（3）ROC 曲线显示，血浆 Ghrelin 水平预测 AMI 患者心力衰竭的曲线下面积（AUC）为 0.72〔95%CI（0.65，0.86）〕，血浆 BNP 水平为 0.77〔95%CI（0.70，0.83）〕，二者联合为 0.89〔95%CI（0.74，0.96）〕。结论　血浆 Ghrelin、BNP 水平是 AMI 患者心力衰竭的独立影响因素，且二者联合检测对 AMI 患者心力衰竭的预测价值较高。

Abstract：

Background　Heart failure is the primary cause of poor prognosis in patients with acute myocardialinfarction（AMI），therefore early identification of population with high-risk heart failure and optimizing the individualizedtreatment became hot spots and difficulties in clinical researches at present. Objective　To investigate the relations of plasmalevels of Ghrelin and BNP to heart failure in patients with AMI. Methods　A total of 108 patients with AMI were selected in theJi'nan City People's Hospital and the Fourth People's Hospital of Ji'nan from January 2016 to January 2018，and they weredivided into HF group（n=18） and non-HF group（n=90） according to the incidence of heart failure during the 12-monthsfollowed-up. Clinical features as well as plasma levels of Ghrelin and BNP were compared between the two groups；multivariateLogistic regression analysis was used to analyze the influencing factors of heart failure in patients with AMI；ROC curve wasdrawn to evaluate the predictive value of plasma levels of Ghrelin，BNP and combination of the above two on heart failurein patients with AMI. Results　（1）Incidence of heart failure in patients with AMI was 16.67%（18/108）in this study.Proportion of patients underwent emergency PCI and plasma Ghrelin level in HF group were statistically significantly lower thanthose in non-HF group，number of stenosed coronary arteries in HF group was statistically significantly more than that in non-HF group，while plasma BNP level in HF group was statistically significantly higher than that in non-HF group，moreover therewas statistically significant difference in PCI types and location of coronary artery lesions between the two groups，respectively（P<0.05）；there was no statistically significant difference in male ratio，age，smoking rate，incidence of diabetes orhypertension，proportion of patients with ST-segment elevation，GRACE score or Gensini score between the two groups （P>0.05）.（2）Multivariate Logistic regression analysis results showed that，number of stenosed coronary arteries〔OR=1.397，95%CI（1.204，1.622），plasma levels of Ghrelin OR=1.278，95%CI（1.105，1.477）〕and BNP〔OR=1.478，95%CI（1.328，1.643）〕were independent influencing factors of heart failure in patients with AMI（P<0.05）.（3）ROC curve showed that，AUC of plasma levels of Ghrelin，BNP and combination of the above two was 0.72〔95%CI （0.65，0.86）〕，0.77 〔95%CI （0.70，0.83）〕and 0.89〔95%CI（0.74，0.96）〕，respectively. Conclusion　Plasma levels of Ghrelin and BNP are independentinfluencing factors of heart failure in patients with AMI，and combined detection of the above two has relatively high predictivevalue on heart failure in patients with AMI.

ReferenceList：