Li Xinfeng, Zhang Ting, Xing Wen
Department of Medical Laboratory, Xianyang Central Hospital No. 78 Renmin East Road, Weicheng District, Xianyang 712000, Shaanxi, China.
Operation Room, Xianyang Central Hospital No. 78 Renmin East Road, Weicheng District, Xianyang 712000, Shaanxi, China.
Am J Transl Res. 2024 Jul 15;16(7):2940-2952. doi: 10.62347/GSBB6486. eCollection 2024.
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).
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.
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.
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.
分析脂蛋白相关磷脂酶A2（Lp-PLA2）、脑钠肽前体N末端（NT-proBNP）及外周血相关比值在急性心肌梗死（AMI）患者早发梗死初诊时对心力衰竭（HF）的预测价值。
本回顾性分析纳入了2020年2月至2023年2月在咸阳市中心医院首次诊断为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）和未发生HF的患者（非HF组，NHF，n = 106）。比较两组初诊时Lp-PLA2、NT-proBNP及外周血比值的差异。采用二元逻辑回归确定HF的独立危险因素，并基于这些因素建立列线图模型。
HF组的心率（HR）（P = 0.032）、C反应蛋白（CRP）（P < 0.001）、谷丙转氨酶（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值（NLR）（P < 0.001）、Lp-PLA2（P < 0.001）和NT-proBNP（P < 0.001）显著高于非HF组。HF组的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）显著更低。多因素逻辑回归确定HR（P = 0.034）、CRP（P = 0.028）、CALDS（P = 0.007）、NLR（P = 0.001）、Lp-PLA2（P = 0.001）和NT-proBNP（P = 0.002）为HF的独立预测因素。NLR、Lp-PLA2和NT-proBNP的曲线下面积（AUC）分别为0.806、0.849和0.780。列线图模型的AUC为0.964，根据德龙检验显著优于单个指标，突出了其优越的预测效能。
HR、CRP、CALDS、NLR、Lp-PLA2和NT-proBNP被确定为AMI后HF的独立预测因素。构建的列线图模型为临床早期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。
