血浆和肽素对ST段抬高型急性心肌梗死患者住院期间发生主要不良心脏事件的评估价值

摘要

目的：探讨血浆和肽素水平对ST段抬高型急性心肌梗死（STEAMI）患者住院期间主要不良心脏事件（MACE）的临床评估价值。　　方法：2012-06至2014-06采用酶联免疫吸附法（ELISA）测定80例STEAMI（STEAMI组）患者及80例稳定性冠心病（对照组）患者血浆和肽素水平，观察STEAMI患者住院期间MACE发生情况。　　结果：STEAMI组患者血浆和肽素水平为（523.26±142.69）pg/ml，对照组血浆和肽素水平为（345.25±89.36）pg/ml，差异有统计学意义（P<0.05）。STEAMI组院内发生MACE者共有28例（35.00％），与（未发生）非MACE者相比，MACE者血浆和肽素、血心肌肌钙蛋白I（cTnI）、肌酸激酶MB同工酶（CK-MB）、左心室射血分数（LVEF）水平显著升高，差异有统计学意义（P<0.05）。经Logistic多因素分析显示，血浆和肽素、心肌肌钙蛋白I、左心室射血分数是STEAMI住院期间发生MACE的独立危险因素。经接受者操作特性曲线下面积显示，血浆和肽素水平对STEAMI住院期间发生MACE的接受者操作特性曲线下面积、阳性预测值、阴性预测值、灵敏性及特异性显著高于心肌肌钙蛋白I、肌酸激酶MB同工酶浓度，差异有统计学意义（P<0.05）。　　结论：血浆和肽素能有效预测STEAMI患者住院期间MACE的发生，对STEAMI患者预后判断具有一定的预测价值。%Objective: To explore the clinical value of plasma copeptin level on major adverse cardiovascular event (MACE) occurrence in patients with acute ST-segment elevation myocardial infarction (STEMI) during hospitalization. Methods: Our research included 2 groups:STEMI group, n=80 and Control group, n=80 patients with stable coronary artery disease (CAD). All patients were treated in our hospital from 2012-06 to 2014-06. Plasma level of copeptin was detected by ELISA, other relevant examinations were conducted to study the MACE occurrence in STEMI patients. Results: Plasma copeptin level in STEMI group (523.26 ± 142.69) pg/ml was higher than that in Control group (345.25 ± 89.36) pg/ml, P<0.05. In STEMI group, there were 28/80 (35%) patients suffered from MACE, compared with non-MACE patients, they had increased plasma copeptin, cardiac muscle protein I (cTnI), kinase isoenzyme (CK-MB) and left ventricular ejection fraction (LVEF), P<0.05. Multivariate regression analysis indicated that plasma copeptin, cTnI and LVEF were the independent risk factors for MACE occurrence. According to occurred area under the curve, compared with cTnI and CK-MB, plasma copeptin level had the higher predictive value to judge the ROC, positiveegative possibility, sensitivity and speciifcity for MACE occurrence in STEAMI patients, P<0.05. Conclusion: Plasma copeptin level could effectively predict MACE occurrence in patients with acute STEMI during hospitalization, it may predict their prognosis at certain point.