| Background and objective:Acute ST-segment elevation myocardial infarction(STEMI)is a critical disease of coronary heart disease.With the opening of the green channel and the establishment of chest pain center,the rate of myocardial reperfusion therapy has been greatly improved,the mortality in the acute phase has been decreased,and the short-term survival rate has been improved.The most common complication of STEMI is the occurrence of heart failure after myocardial infarction,which is one of the key factors causing poor prognosis.Controlling heart failure after myocardial infarction can greatly improve its prognosis.In addition to treatment,prevention should be carried out to reduce the occurrence of heart failure after myocardial infarction.How to reduce the incidence of heart failure.Compared with treatment,more attention should be paid to early prediction and prevention.Ventricular remodeling after myocardial infarction is the cause of heart failure,and ventricular remodeling is closely related to the activation and degree of inflammatory response in STEMI.The more severe the inflammation,the greater the injury and the more severe the remodeling.Neutrophils and NGAL participate in the inflammatory response of heart failure as inflammatory mediators,and undergo significant changes in this process.They are involved in the early stage of myocardial infarction,and their initial changes may precede the changes of dominant heart failure indicators.Whether the neutrophil and NGAL levels in the early stage(within 24 hours of onset)are related to early heart failure after myocardial infarction,can predict the occurrence of early heart failure after myocardial infarction,and then send out the danger signal as early as possible,guide the clinical active prevention of heart failure or treatment of heart failure,improve its prognosis,prolong the life cycle of patients and improve the quality of life.Method:Patients with STEMI diagnosed for the first time and undergoing emergency PCI within24 hours in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Dali University from January 2022 to September 2022 were collected as the research objects.All patients were informed consent and approved by the Ethics committee of the First Affiliated Hospital of Dali University.A total of 148 patients were included,and 59 patients who did not meet the inclusion criteria were excluded.A total of 89 patients were enrolled in the study.The general information of the subjects,routine related serological indicators within 24 hours,serum samples were collected and NGAL levels within 24 hours were detected by enzyme-linked immunosorbent assay.1.According to the occurrence of heart failure during hospitalization,the subjects were divided into heart failure group(42 cases)and non-heart failure group(47 cases),and the data between the two groups were compared.The measurement data were analyzed by independent sample t test,and the count data were analyzed by chi-square test.Among them,this study found that neutrophils and NGAL levels were related factors.2.According to Killip classification of cardiac function,the patients were divided into Killip I(47 cases),Killip II(21 cases),Killip III(12 cases)and Killip IV(9 cases).Univariate analysis was used to compare whether there were statistical differences in neutrophil and NGAL levels among the four groups in different cardiac function grades,and to further find the correlation between them and heart failure.3.Correlation analysis was used to analyze the correlation between neutrophils and early heart failure related factors after myocardial infarction and echocardiography LVEDD.4.Correlation analysis was used to analyze the correlation between NGAL level and early heart failure related factors after myocardial infarction and echocardiography LVEDD.5.Binary Logistic regression analysis was used to screen the independent risk factors for early heart failure after myocardial infarction,and to determine whether neutrophil and NGAL were independent risk factors for early heart failure after myocardial infarction.6.Finally,the ROC curve was drawn with neutrophils and NGAL levels as test variables and heart failure as state variables.According to the best Youden index,the cut-off values of neutrophils,NGAL and neutrophils+NGAL were selected to conclude that they had predictive effects.The sensitivity,specificity and predictive efficacy of each optimal cut-off value were calculated,and all data were analyzed by SPSS25.0 analysis software.Graphs were drawn using Graph Pad Prism 8.0 software.Result:1.There were no significant differences in age,gender,history of hypertension,diabetes,smoking,ejection fraction,BMI,TC,TG,LDL-C,HDL-C,Cr,UA,AST,ALT,and ALB between the heart failure group and the non-heart failure group(P>0.05).There were significant differences in c Tn I,BNP,IL-6,neutrophil,NGAL levels,LVEDD and GRACE score between the two groups(all P<0.05).2.According to the Killip classification of cardiac function,the NGAL levels of Killip II,III,IV were significantly different from Killip I(P<0.001).There was a significant difference in NGAL levels between Killip II and III groups(P<0.05).There was a significant difference in NGAL levels between Killip grade II and grade IV groups(P<0.001).There were significant differences in the levels of neutrophils between Killip grade III,IV and Killip grade I(P<0.001),and between Killip grade II and Killip grade IV(P=0.001).3.Neutrophils were positively correlated with c Tn I,BNP and GRACCE score(P<0.05),but not with LVEDD(P>0.05).4.NGAL level was positively correlated with c Tn I,BNP and GRACCE score(P<0.05),but not with LVEDD(P>0.05).5.Binary Logistic regression analysis showed that IL6,NGAL,GRACE score,neutrophils and c Tn I were related to heart failure,among which neutrophils and NGAL were independent risk factors for heart failure.6.Taking neutrophil and NGAL levels as test variables and heart failure as state variable,the ROC curve was drawn:The area under curve(AUC)of neutrophils,NGAL and neutrophils+NGAL were 0.780,0.892 and 0.918,respectively,and 95%CI were 0.6822-0.877,0.826-0.958and 0.863-0.974,respectively.Neutrophils,NGAL and neutrophils+NGAL all have predictive value for early heart failure after myocardial infarction.After analyzing the cut-off values and corresponding sensitivity and specificity of neutrophils,NGAL and neutrophils+NGAL,it was found that when neutrophils were greater than 7.32×10~9/L within 24 hours of STEMI,early heart failure after myocardial infarction was more likely to occur.When NGAL was greater than 22.35ng/ml,NGAL was more than 22.35ng/ml.Early heart failure after myocardial infarction is more likely.It is not difficult to see that the combination of neutrophils and NGAL has the best predictive effect on heart failure after myocardial infarction,followed by NGAL alone,and finally neutrophils.Conclusion:1.Neutrophil and NGAL levels within 24 hours after STEMI are correlated with early heart failure after myocardial infarction.2.Neutrophil and NGAL levels within 24 hours are independent risk factors for early heart failure after myocardial infarction in STEMI patients.3.Neutrophils,NGAL,neutrophils+NGAL in patients with STEMI within 24 hours have predictive value for early heart failure after myocardial infarction.When neutrophils>7.32×10~9/L and NGAL>22.35ng/ml,early heart failure after myocardial infarction is more likely to occur.The predictive value of neutrophil combined with NGAL for heart failure after myocardial infarction is stronger than that of NGAL,and the predictive value of NGAL is stronger than that of neutrophils. |
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