作者：门汝梅，王艳林，张琳娜，门丽丽，兰文达，孟庆兰，王鑫，于建才

单位：

1.河北省沧州市人民医院心内三科2.河北省沧州中西医结合医院手显微外二科3.河北省沧州市人民医院绩效办4.河北省沧州市中心医院心内二科

Units：

1.Department of Third Cardiology, CANGZHOU People's Hospital, Cangzhou 061000, China 2.Second Hand Microsurgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou 061001, China 3.Performance Office, CANGZHOU People's Hospital, Cangzhou 061000, China 4.Department of Second Cardiology, Cangchou Central Hospital, Cangzhou 061000, China

关键词：

ST段抬高型心肌梗死; 肺动脉收缩压; 经皮冠状动脉介入术; 心力衰竭; 死亡;

Keywords：

ST elevation myocardial infarction; Pulmonary artery systolic pressure; Percutaneous coronary intervention; Heart failure; Death

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2023.00.123

Funds：

2022年度河北省医学科学研究课题计划（20220379）；

摘要：

目的 探讨肺动脉收缩压（PASP）与急性ST段抬高型心肌梗死（STEMI）患者PCI后发生再住院心力衰竭与死亡的关系。方法 回顾性选取2016年1月至2017年5月于沧州市人民医院行PCI的急性STEMI患者153例。将入院时PASP>35 mm Hg的患者纳入高压组（n=71），其余患者作为非高压组（n=82）。收集患者临床资料、心功能指标、PCI后再住院心力衰竭发生及死亡情况。采用Pearson相关分析探讨PASP与急性STEMI患者左心室射血分数（LVEF）、N末端脑钠肽前体（NT-proBNP）的相关性。采用ROC曲线探讨PASP对急性STEMI患者PCI后发生再住院心力衰竭的预测价值。采用单因素、多因素Cox比例风险回归分析探讨PASP与急性STEMI患者PCI后死亡的关系。采用Kaplan-Meier法绘制生存曲线，并进行生存分析。结果 高压组NT-proBNP高于非高压组，LVEF、左心室缩短分数（LVFS）低于非高压组（P<0.05）。Pearson相关分析结果显示，急性STEMI患者PASP与NT-proBNP呈正相关（r=0.673,P<0.001），与LVEF呈负相关（r=-0.652,P<0.001）。ROC曲线分析结果显示，PASP预测急性STEMI患者PCI后发生再住院心力衰竭的AUC为0.79[95%CI(0.68,0.83)]，最佳截断值为35.2 mm Hg，灵敏度为71.0%，特异度为78.8%。单因素、多因素Cox比例风险回归分析结果显示，PASP>35 mm Hg是急性STEMI患者PCI后死亡的独立危险因素（P<0.05）。生存曲线分析结果显示，高压组生存率低于非高压组（χ2=12.198,P<0.001）。结论 PASP对急性STEMI患者PCI后发生再住院心力衰竭具有中等预测价值，且PASP>35 mm Hg是急性STEMI患者PCI后死亡的危险因素。

Abstract：

　Objective To investigate the relationship between pulmonary arterial systolic pressure (PASP) and re-hospitalization for heart failure and death in patients with acute ST-segment elevation myocardial infarction (STEMI) after PCI. Methods A total of 153 patients with acute STEMI who underwent PCI in CANGZHOU People's Hospital from January 2016 to May 2017 were retrospectively selected. Patients with PASP > 35 mm Hg at admission were divided into high-pressure group (n=71) , and the rest patients were divided into non-high-pressure group (n=82) . Clinical data, cardiac function indexes, occurrence of re-hospitalization for heart failure and death after PCI were collected. Pearson correlation analysis was used to investigate the correlation between PASP and left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in acute STEMI patients. ROC curve was used to investigate the predictive value of PASP for re-hospitalization for heart failure in acute STEMI patients after PCI. Univariate and multivariate Cox proportional risk regression analysis were used to investigate the relationship between PASP and death in acute STEMI patients after PCI. Kaplan-Meier method was used to draw survival curve, and survival analysis was conducted. Results NT-proBNP in high-pressure group was higher than that in non-high-pressure group, LVEF and left ventricular fractional shortening (LVFS) in high-pressure group were lower than those in non-high-pressure group (P < 0.05) . Pearson correlation analysis results showed that PASP was positively correlated with NT-proBNP (r=0.673, P < 0.001) in acute STEMI patients, and negatively correlated with LVEF (r=-0.652, P < 0.001) . ROC curve analysis showed that the AUC of PASP in predicting re-hospitalization for heart failure in acute STEMI patients after PCI was 0.79 [95%CI (0.68, 0.83) ] , the optimal cut-off value was 35.2 mm Hg, the sensitivity was 71.0%, the specificity was 78.8%. Univariate and multivariate Cox proportional risk regression analysis showed that PASP > 35 mm Hg was an independent risk factor for death in acute STEMI patients after PCI (P < 0.05) . The results of survival curve analysis showed that the survival rate of high-pressure group was lower than that of non-high-pressure group (χ2 =12.198, P < 0.001) . Conclusion PASP is of moderate predictive value for re-hospitalization for heart failure in acute STEMI patients after PCI, and PASP > 35 mm Hg is a risk factor for death in acute STEMI patients after PCI.

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