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

摘要： 背景　急性心肌梗死（AMI）是目前临床上导致患者心源性猝死的重要因素，一般患者发生AMI极易导致心肌受损从而导致急性心力衰竭（AHF）的发生，早期诊断AMI患者发生AHF对改善患者预后、降低死亡风险具有积极的意义，目前临床上对于AHF的主要诊断依据为脑钠肽（BNP），但影响BNP的相关因素较多，且达到有诊断意义的值时AHF已经发生，严重影响患者预后及生存情况，故需要更为准确的诊断方式在AMI发生早期对AHF进行预测。目的　探讨糖原蛋白125（CA-125）联合脑源性神经营养因子（BDNF）预测老年AMI患者发生AHF的诊断价值。方法　纳入2019年3月—2020年3月安徽医科大学第二附属医院心内科收治的AMI患者144例，收集所有患者入院时的临床资料，入院后抽取患者空腹静脉血，采用全自动免疫分析仪测定血清CA-125和BDNF水平，根据冠状动脉再灌注治疗后1周内是否发生AHF分为心力衰竭组（42例）和对照组（102例），对比两组患者临床资料，采用多因素Logistic回归分析影响AMI患者发生AHF的独立危险因素；绘制受试者工作特征（ROC）曲线，分析CA-125联合BDNF对老年AMI患者AHF的预测价值。结果　心力衰竭组患者肌钙蛋白（cTnI）、BNP、CA-125、BDNF高于对照组，病变支数多于对照组（P<0.05）；多因素Logistic回归分析显示，BNP〔OR=1.015，95%CI （1.003，1.026）〕、CA-125〔OR=23.228，95%CI（4.095，131.748）〕、BDNF〔OR=1.455，95%CI（1.148，1.845）〕水平升高是导致AMI患者发生AHF的独立危险因素（P<0.05）；ROC曲线显示，CA-125联合BDNF预测AMI患者发生AHF的ROC曲线下面积高于CA-125和BDNF单独预测（P<0.05），其诊断AHF的灵敏度为78.57%，特异度为89.22%。结论　通过监测血清CA-125和BDNF水平能够有效预测老年AMI患者发生AHF风险。

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