冠心病病人N端前脑钠肽检测的临床意义

Determinafion of serum N-terminal pro-B-type natriuretic peptide and its clinical significance in patients with coronary heart disease

目的观察不同临床类型冠心病病人的血清N端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度的差异及其与心肌坏死标记物的相关性,并探讨其临床意义。方法经冠状动脉造影证实的冠心病病人106例,按临床类型分为:急性心肌梗死28例,不稳定型心绞痛36例,稳定型心绞痛42例。对照组22例非冠心病者。采用电化学发光法测定血清NT-proBNP浓度,同时定量测定急性心肌梗死病人的肌钙蛋白I(cardiac troponin I,cTnI)。结果急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组和对照组血清NT-proBNP浓度分别为(573±126)ng/L,(276±65)ng/L,(42±23)ng/L,(37±24)ng/L。急性心肌梗死组NT-proBNP与cTnI呈正相关(r=0.913,P<0.01)。结论不同临床分型的冠心病病人的血清NT-proBNP浓度存在差异,NT-proBNP可反映心肌缺血的程度。

Objectives To explore the relationship between serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and clinical phenotypes of coronary heart disease (CHD) and the correlation between NT-proBNP and troponin I(TnI). Methods 106 patients with CHD were enrolled in this study and 22 persons without CHD were selected as control. Clinical phenotypes of CHD included acute myocardial infarction (AMI),unstable angina pectoris (UAP) and stable angina pectoris (SAP). Serum levels of NT-proBNP were measured with automated electrochemiluminescence immunoassay in all patients. Correlation between NT-proBNP and TnI which was detected at the same time with NT-proBNP was also analyzed in AMI group. Results Serum level of NT-proBNP were (573±126) pg/mL,(276±65)pg/ml,(42±23) pg/ml and (37±24) pg/mL in the patients with AMI,UAP,SAP and control, respectively. The level of NT-proBNP was significantly higher in AMI than that in other three groups (P<0.01);the level of NT-proBNP was significantly higher in UAP than that in SAP or control(P<0.01);there were no significant difference in NT-proBNP levels between SAP and control(P>0.05). NT-proBNP level were highly correlated with TnI in AMI(r=0.913,P<0.01). Conclusions Serum level of NT-proBNP are associated with clinical phenotypes of coronary heart disease and it may reflect degree of myocardial necrosis.