关键词: 急性心肌梗死, 心力衰竭, N-末端脑钠肽前体, 同型半胱氨酸, 载脂蛋白A

Abstract:

Objective： To investigate the correlation between N-terminal pro-brain natriuretic peptide （NT-pro BNP）， homocysteine （Hcy） and apolipoprotein A （Apo-A） and the heart failure （HF） degree and prognosis in patients with acute myocardial infarction （AMI）.Methods： 100 patients with AMI admitted to our hospital from January 2021 to December 2023 were selected as the research objects， and were divided into the HF group （n=44） and the non-HF group （n=56） according to whether they had HF. Serum NT-pro BNP， Hcy and Apo-A levels of all patients were detected， and the HF degree of patients in the HF group was evaluated by Killip grading. Patients in the HF group were divided into good prognosis group （n=24） and poor prognosis group （n=20） according to the prognosis. The influencing factors of poor prognosis of AMI patients were analyzed by univariate and multifactorial analysis， and the receiver operating curve （ROC） was used to analyze the prognostic value of serum NT-pro BNP， Hcy and Apo-A levels in patients with AMI combined with HF.Results： The levels of serum NT-pro BNP， Hcy and Apo-A of patients in the HF group were higher than those in non-HF group （P < 0.05）. The levels of serum NT-pro BNP， Hcy and Apo-A of patients in HF grade Ⅳ group were higher than those in grade Ⅲ and grade Ⅱ groups， and the levels of serum NT-pro BNP， Hcy and Apo-A of patients in HF grade Ⅲ group were higher than those in grade Ⅱ group （P < 0.05）. Spearson correlation analysis showed that serum NT-pro BNP， Hcy and Apo-A levels were positively correlated with HF degrees （r=0.612， 0.505， 0.649， P < 0.05）. There were statistically significant differences in age， history of hyperlipidemia， cardiac enlargement， NT-pro BNP， Hcy and Apo-A levels between the two groups of patients （P < 0.05）. Logistic regression analysis showed that age， NT-pro BNP， Hcy and Apo-A levels were the prognostic factors of AMI patients with HF （P < 0.05）. The AUC of serum NT-pro BNP level in predicting prognosis of AMI patients with HF was 0.769 （0.617-0.882）， the sensitivity was 75.00%， and the specificity was 79.17% （P < 0.05）. The AUC of serum Hcy level in predicting prognosis of AMI patients with HF was 0.833 （0.690~0.928）， the sensitivity was 95.00%， and the specificity was 58.33% （P < 0.05）.The AUC of serum Apo-A level in predicting prognosis of AMI patients with HF was 0.877 （0.743-0.957）， the sensitivity was 85.00%， and the specificity was 91.67% （P < 0.05）.Conclusion： Serum NT-pro BNP， Hcy and Apo-A levels increase with the increase of the degree of HF in AMI patients， which are closely related to the prognosis of AMI patients with HF and have high predictive value.

Key words:  , Acute myocardial infarction； , Heart failure； , N-terminal pro-brain natriuretic peptide； , Homocysteine； , Apolipoprotein A