目的:分析脂蛋白相关磷脂酶A2(Lp-PLA2)的预测价值,N末端脑钠肽原激素(NT-proBNP),以及急性心肌梗死(AMI)患者早发性梗死后心力衰竭(HF)的初始诊断时的外周血相关比率。
方法:本回顾性分析纳入咸阳市中心医院2020年2月至2023年2月首次诊断为AMI的151例患者。患者分为两组:住院期间发生HF的患者(HF组,n=45)和那些没有(非HF组,NHF,n=106)。Lp-PLA2、NT-proBNP、两组之间比较了初始诊断时的外周血比率。二元logistic回归用于确定HF的独立危险因素,并根据这些因素建立了列线图模型。
结果:HR(P=0.032),C反应蛋白(CRP)(P<0.001),丙氨酸转氨酶(ALT)(P=0.015),冠状动脉病变评分(CALDS)(P<0.001),D-二聚体(D-D)(P=0.021),中性粒细胞与淋巴细胞比率(NLR)(P<0.001),Lp-PLA2(P<0.001),HF组NT-proBNP(P<0.001)明显高于NHF组。HF组左心室收缩末期内径(LVESD)(P<0.001)和左心室舒张末期内径(LVEDD)(P<0.001)明显较低。多因素logistic回归确定了HR(P=0.034),CRP(P=0.028),CALDS(P=0.007),NLR(P=0.001),Lp-PLA2(P=0.001),NT-proBNP(P=0.002)是HF的独立预测因子。NLR的AUC,Lp-PLA2和NT-proBNP分别为0.806、0.849和0.780。列线图模型的AUC为0.964,根据德隆检验,显著优于个别指标,突出了其优越的预测功效。
结论:HR,CRP,CALDS,NLR,Lp-PLA2和NT-proBNP被确定为AMI后HR的独立预测因子。构建的列线图模型为早期临床识别高危患者提供了有效的工具,可能改善预后并指导治疗策略。
OBJECTIVE: To analyze the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and peripheral blood-related ratios at the initial diagnosis for heart failure (HF) after early-onset infarction in patients with acute myocardial infarction (AMI).
METHODS: This retrospective analysis included 151 patients first diagnosed with AMI at Xianyang Central Hospital from February 2020 to February 2023. Patients were classified into two groups: those who developed HF during hospitalization (HF group, n=45) and those who did not (non-HF group, NHF, n=106). Differences in Lp-PLA2, NT-proBNP, and peripheral blood ratios at initial diagnosis were compared between the groups. Binary logistic regression was used to identify independent risk factors for HF, and a nomogram model was developed based on these factors.
RESULTS: HR (P=0.032), C-reactive protein (CRP) (P<0.001), alanine aminotransferase (ALT) (P=0.015), coronary artery lesion score (CALDS) (P<0.001), D-dimer (D-D) (P=0.021), neutrophil-to-lymphocyte ratio (NLR) (P<0.001), Lp-PLA2 (P<0.001), and NT-proBNP (P<0.001) were significantly higher in the HF group than in the NHF group. Left ventricular end-systolic diameter (LVESD) (P<0.001) and left ventricular end-diastolic diameter (LVEDD) (P<0.001) were significantly lower in the HF group. Multifactorial logistic regression identified HR (P=0.034), CRP (P=0.028), CALDS (P=0.007), NLR (P=0.001), Lp-PLA2 (P=0.001), and NT-proBNP (P=0.002) as independent predictors of HF. The AUCs for NLR, Lp-PLA2, and NT-proBNP were 0.806, 0.849, and 0.780, respectively. The nomogram model achieved an AUC of 0.964, significantly outperforming individual indicators per Delong\'s test, highlighting its superior predictive efficacy.
CONCLUSIONS: HR, CRP, CALDS, NLR, Lp-PLA2, and NT-proBNP were identified as independent predictors of HR post-AMI myocardial infarction. The constructed nomogram model provides an effective tool for early clinical identification of high-risk patients, potentially improving prognosis and guiding therapeutic strategies.