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目的研究中青年前壁急性心肌梗死患者急性期脑利钠肽(BNP)和肌钙蛋白I(TnI)水平与远期运动耐量的相关性。方法临床确诊的32例中青年前壁急性心肌梗死患者,根据左心室射血分数(LVEF)分为两组(LVEF≥50%组20例,LVEF<50%组12例),分别测定3 d、2周和6个月的BNP和TnI值,6 min步行试验评价心肌梗死后6个月的运动耐量。对BNP与TnI、BNP与运动耐量、TnI与运动耐量分别进行相关性分析,并以运动耐量作因变量,BNP和TnI做自变量进行回归分析。结果 (1)LVEF≥50%与<50%组心肌梗死后3 d、2周和6个月BNP水平差异均有统计学意义(P<0.01),而在3 d和6个月的时段,TnI在LVEF≥50%和LVEF<50%两组间差异有统计学意义(P<0.05)。6个月两组的6 min步行距离差异有统计学意义(P<0.01)。(2)在LVEF≥50%组和LVEF<50%组,急性期BNP分别与TnI和运动试验结果相关,而TnI与运动试验没有明显相关性。全部患者TnI与运动耐量的相关系数为-0.556(P<0.01)。(3)无论使用LVEF分组与否,逐步回归分析显示,只有急性期BNP可以与6个月6 min步行距离进行回归,全部患者BNP逐步回归系数为0.672(P<0.01)。结论前壁心肌梗死患者急性期血BNP和TnI与运动耐量有一定相关性。但BNP比TnI对运动耐量有更好的独立预测作用。
Objective To study the correlation between the levels of brain natriuretic peptide (BNP) and troponin I (TnI) and long-term exercise tolerance in young and middle-aged patients with acute myocardial infarction. Methods According to the left ventricular ejection fraction (LVEF), 32 patients with acute anterior myocardial infarction were divided into two groups (20 in LVEF≥50% group and 12 in LVEF <50% group) , BNP and TnI values at 2 weeks and 6 months, and 6-minute walking test to evaluate exercise tolerance at 6 months after myocardial infarction. BNP and TnI, BNP and exercise tolerance, TnI and exercise tolerance were analyzed separately, and exercise tolerance as a dependent variable, BNP and TnI as independent variables for regression analysis. Results (1) There were significant differences in BNP levels at 3, 2 and 6 months after LVEF≥50% and <50% myocardial infarction (P <0.01), but at 3 and 6 months, TnI in LVEF≥50% and LVEF <50% difference between the two groups was statistically significant (P <0.05). The difference of 6-minute walking distance between the two groups at 6 months was statistically significant (P <0.01). (2) In LVEF≥50% group and LVEF <50% group, BNP in acute phase correlated with TnI and exercise test results respectively, while TnI had no significant correlation with exercise test. The correlation coefficient of TnI and exercise tolerance in all patients was -0.556 (P <0.01). (3) The stepwise regression analysis showed that only the acute BNP regressed with walking distance of 6 months and 6 months 6 months, and the stepwise regression coefficient of BNP in all patients was 0.672 (P <0.01). Conclusion Acute phase of anterior wall myocardial infarction patients with blood BNP and TnI and exercise tolerance have a certain correlation. However, BNP had better independent predictors of exercise tolerance than TnI.