rhBNP 对急性前壁心肌梗死患者sST2、 hs-cTnI、心功能的影响及其预后分析

Effects of rhBNP on sST2, hs-cTnI, and cardiac function in patients with acute anterior myocardial infarction and prognostic analysis

摘要:

目的 探讨重组人脑利钠肽（rhBNP）对急性前壁心肌梗死患者可溶性ST2 蛋白（sST2）、超 敏肌钙蛋白I（hs-cTnI）、心功能的影响及其预后情况。方法 选取2016 年1 月—2017 年1 月在贺州市人民 医院住院治疗的急性前壁心肌梗死患者120 例，按简单随机分组法分为对照组和rhBNP 组，各60 例。对照 组给予标准药物治疗，rhBNP 组在对照组基础上加用rhBNP。测定两组患者入院时、入院7 d 左室舒张末内 径（LVEDD）、左室射血分数（LVEF）；分析两组患者入院时，以及24 和7 d 的sST2、脑钠肽（BNP）、hscTnI 。对患者进行1 年随访，记录患者主要心脏不良事件（MACE）的发生情况及发生时间，对两组患者的 预后进行比较；应用Cox 比例风险模型分析影响患者术后并发症发生的危险因素。结果 sST2、BNP、hscTnI 、LVEDD、LVEF 在不同时间、不同组间及变化趋势上有差异（P <0.05），对照组sST2、BNP、hs-cTnI、 LVEDD 较高，LVEF 较低（P <0.05）。rhBNP 组MACE 发生率均低于对照组（P <0.05），rhBNP 组预后更好 （P <0.05）。单因素分析和多因素分析结果显示，rhBNP[Hl ^ R=0.799（95% CI：0.808，1.211）]、sST2[Hl ^ R=1.651 （95% CI ：1.037，2.132）]、BNP[Hl ^ R=1.235（95% CI ：0.702，1.390）]、hs-cTnI[Hl ^ R=1.331（95% CI ：1.095， 3.113）] 是影响患者预后的独立危险因素（P <0.05）。结论 rhBNP 治疗急性前壁心肌梗死患者效果显著，且 可降低患者MACE 发生率，改善预后。

Abstract:

Objective To investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on soluble ST2 protein (sST2), high-sensitivity cardiac troponin I (hs-cTnI), and cardiac function in patients with acute anterior myocardial infarction and its prognostic analysis. Methods Selected 120 patients with acute anterior myocardial infarction hospitalized in our hospital were randomly divided into control group (n = 60) and rhBNP group (n = 60) according to simple randomization method. The control group was given standard drug therapy, while rhBNP group was additionally given rhBNP based on the standard treatment. The left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured at admission and 7 d after admission in the two groups. The serum levels of sST2, brain natriuretic peptide (BNP), and serum hs-cTnI were determined at the time of admission, 24 h after admission, and 7 d after admission. The patients were followed up for 1 year, and the time of major adverse cardiac events (MACE) was recorded. The prognosis of the two groups of patients was compared. Cox proportional hazards model was used to analyze the risk factors affecting postoperative complications. Results ① The sST2, BNP, hs-cTnI, LVEDD, and LVEF in the rhBNP group and the control group were different in distinct time periods (P < 0.05). ② The sST2, BNP, hs-cTnI, LVEDD, and LVEF were different between the rhBNP group and the control group (P < 0.05). Specifically, the rhBNP group had lower sST2, BNP, hscTnI and LVEDD but higher LVEF than the control group. ③ The changing trend of sST2, BNP, hs-cTnI, LVEDD, and LVEF between the rhBNP group and the control group was different (P < 0.05). Within 1 year of follow-up, the incidence of MACE in the rhBNP group was lower than that of the control group (P < 0.05), and the prognosis in the rhBNP group was better than that in the control group (P < 0.05). Univariate analysis showed that rhBNP, sST2, BNP, and hs-CTnI all had significant differences (P < 0.05), and multivariate regression analysis showed that rhBNP [Hl ^ R =0.799, (95% CI: 0.808, 1.211)], sST2 [Hl ^ R =1.651, (95% CI: 1.037, 2.132)], BNP [Hl ^ R =1.235, (95% CI: 0.702, 1.390)] and hs-cTnI [Hl ^ R =1.331, (95% CI: 1.095, 3.113)] were all risk factors that affected the prognosis of patients (P < 0.05). Conclusions The rhBNP has a significant therapeutic effect on acute anterior myocardial infarction, and can reduce the incidence of MACE and improve the prognosis of patients.