关键词: 急性心肌梗死, 急性心力衰竭, 老年人, 糖原蛋白125, 脑源性神经营养因子, 预测价值, 灵敏度, 特异度

Abstract: Background　Acute myocardial infarction （AMI） is currently an important clinical cause of sudden cardiac death in patients. The occurrence of AMI in general patients can easily lead to myocardial damage，which can lead to acute heart failure （AHF）. Early diagnosis of AHF in AMI patients has positive significance for improving the prognosis of patients and reducing the risk of death. At present，the main clinical diagnosis of AHF is based on brain natriuretic peptide （BNP），but there are many related factors which can affect BNP，and when BNP reaches a diagnostically meaningful value，AHF has occurred in the patient，which may seriously affect the prognosis and survival of the patient. Therefore，a more accurate diagnosis method is needed to predict the occurrence of AHF in the early stage of AMI. Objective　To explore the diagnostic value of glycogen protein 125 （CA-125） combined with brain-derived neurotrophic factor （BDNF） in predicting the occurrence of AHF in elderly patients with AMI. Methods　144 patients with AMI admitted to the Department of Cardiology of The Second Affiliated Hospital of Anhui Medical University from September 2017 to March 2020 were enrolled. The clinical data of all patients were collected at the time of admission and their fasting venous blood was drawn after admission to measure serum CA-125 and BDNF levels by an automatic immunoassay analyzer. The enrolled patients were divided into heart failure group （42 cases） and control group （102 cases） according to whether AHF occurred within 1 week after coronary reperfusion therapy. The clinical data of the two groups were compared，and the multivariate logistic regression was used to analyze the independent risk factors that affect the occurrence of AHF in AMI patients. Receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CA-125 combined with BDNF for AHF in elderly patients with AMI. Results　The patients in the heart failure group had higher cardiac troponin （cTnI）. BNP，CA-125，BDNF，and higher number of diseased branches than the control group （P<0.05）. Multivariate Logistic regression analysis showed that elevated levels of BNP 〔OR=1.015，95%CI （1.003，1.026）〕，CA-125 〔OR=23.228，95%CI （4.095，131.748）〕and BDNF 〔OR=1.455，95%CI （1.148，1.845）〕 were independent risk factors for AHF in AMI patients （P<0.05）. The ROC curve shows that the area under the ROC curve of CA-125 combined with BDNF in prediction of AHF in AMI patients is higher than that of CA-125 and BDNF alone （P<0.05），with a diagnostic sensitivity of 78.57% and a specificity of 89.22%. Conclusion　Monitoring serum CA-125 and BDNF levels can effectively predict the risk of AHF in elderly patients with AMI.

Key words: Acute heart failure, Acute heart failure, Aged, Glycogen protein 125, Brain-derived neurotrophic factor, Predictive value, Sensitivity, Specificity