目的:通过动态监测急性ST 抬高型心肌梗死( STEMI) 病人NT－proBNP 血浆水平，制作时间－浓度
水平曲线，分析影响双峰型NT－proBNP 形成的临床指标，探讨双峰型NT－proBNP 对STEMI 病人预后判断中的
临床价值。方法:入选西安市北方医院2015－08～ 2017－08 收治的STEMI 病人200 例。记录心梗后6 h、12 h、14
h、16 h、18 h、24 h、2 d、3 d、4 d、5 d、6 d、7 d 的NT－proBNP 血浆水平;以年龄、性别、是否有高血压史、是否糖尿病
史、是否为前壁心肌梗死、梗死后48 h 内EF 值是否大于45%、Killip 分级、QＲS 时程是否大于120 ms、心肌酶峰
是否大于400 IU/L、eGFＲ 是否大于60mL/min、是否存在重症感染、是否尿酮体阳性为自变量，以是否双峰型NT
－proBNP 为应变量，采用Logistic 回归分析，建立拟合模型，分析影响形成双峰型NT－proBNP 主要临床变量。以
心梗后28 d 心脏不良事件为临床观察终点，探讨单峰型及双峰型NT－proBNP 预后判断价值。结果: ( 1) 单峰型
STEMI 病人心肌梗死后中位数时间17．6h 出现NT－proBNP 第1 个峰值，峰值均值约4790±1160 pg /mL; 双峰型
NT－proBNP 病人，在中位数时间为4．3d 时出现第2 个峰值。( 2) 通过Logistic 回归分析，建立多自变量拟合模
型，3 个临床指标: 前壁心肌梗死、心肌酶峰值CKMB 大于400 U/L、eGFＲ 小于60mL/min 是形成峰型NT －
proBNP 影响因子。( 3) 双峰型NT－proBNP 与心梗后28 d 主要心脏不良事件关系密切。结论: ( 1) 对于前壁心
肌梗死、心肌酶峰值高及肾功不全的STEMI 病人，应动态监测心梗后NT－proBNP 血浆水平; ( 2) 双峰型NTproBNP
是急性STEMI 病人短期预后不良独立危险因素。

Objective: Dynamic monitoring of serum NT－proBNP levels in patients with acute ST
elevation myocardial infarction，making time－serum curve，analyzing the clinical indicators affecting the
formation of double－peaks type NT－proBNP，investigating the clinical value of double－peaks type NTproBNP
in the prognosis of patients with STEMI．Methods: From August 2015 to August 2017，200 patients
with acute ST segment elevation myocardial infarction were selected from Xi’an North hospital．
Serum levels of 12 h、14 h、16 h、18 h、24h，2 d，3 d，4 d，5 d，6 d and 7 d NT－proBNP after myocardial
infarction were recorded，and time － serum curve was made．We introduce 12 variables: age，gender，
whether there is a history of hypertension，diabetes history，whether EF value is greater than 45%，Killip
grades，whether QＲS duration is greater than 120 ms，the peak myocardial enzymes＞400 IU/L，eGFＲ，
the existence of severe infection，whether the urine ketone body positive，andthe double－peaks type NT
－proBNP is the strain．Logistic regression analysis was used to establish the fitting model and analyze
the main clinical variables affecting the formation of double－peaks type NT－proBNP．Taking the 28 day
MACE after myocardial infarction as the endpoint of clinical observation，we evaluated the prognostic
value of double－peaks type NT－proBNP．Ｒesults: ( 1) The median 17．6h after myocardial infarction
showed the first peak of NT－proBNP，with a peak value of about 4790+1160 pg /mL．In double－peaks
type NT－proBNP patients，second peaks occurred at the median time of 4．3d．( 2) 3 clinical indicators:
anterior wall myocardial infarction，myocardial enzyme peak CKMB greater than 400 U/L，eGFＲ less
than 60mL /min，is the impact of double－peaks type NT－proBNP formation of clinical indicators．( 3)
Double－peak type NT－proBNP is closely related to the 28 day MACE after myocardial infarction．Conclusion:
( 1) The serum levels of NT－proBNP should be monitored dynamically in patients with STEMI
with anterior wall myocardial infarction，high peak myocardial enzymes and renal insufficiency． ( 2)
Double－peaks type NT－proBNP is an independent risk factor for short－term prognosis in patients with
acute STEMI．

Ｒ542．2