B型钠尿肽在急性冠脉综合征中的临床意义

Change of B-type natriuretic peptide level in the patients with acute coronary syndrome and clinical significance

目的研究急性冠脉综合征(ACS)患者血浆B型钠尿肽(BNP)水平对早期临床诊断、危险分层的临床价值。方法对58例ACS患者行心电图、血浆BNP、血清酶(肌红蛋白、肌酸磷酸激酶同工酶、心肌肌钙蛋白I)、超声心动图检查。结果血浆BNP水平在ST段抬高的急性心肌梗死组明显高于非ST段抬高的ACS组(188.46±222.03 pg/mL vs.37.91±52.35pg/mL,P=0.001);左室舒张末径(LVEDD)、左室收缩末径(LVESD)、左房径(LAD)、左室射血分数(LVEF)两组无显著性差异(P>0.05)。血浆BNP浓度与LVEF呈显著负相关(r=-0.393,P<0.05),与LVEDD、LVESD有明显正相关性(r=0.415及0.421,P<0.05)。血浆BNP浓度、cTnI浓度、LVEF与ACS患者近期心脏不良事件明显相关(OR值:2.640、2.782、2.036)。结论血浆BNP浓度是ACS患者一个特异性较好的监测指标,是ACS患者早期危险分层的独立预测因子。

Objective To reveal the inherent correlation between plasma BNP level of acute coronary syndrome patient and severity and prognosis.Methods The 58 samples were selected from acute coronary syndrome patients. All the patients were monitored with regular ECG. Laboratory examinations, such as plasma BNP, myoglobin, creatine kinase MB, cardiac troponin I, and ultrasonic cardiogram to evaluate left ventricular function and haemodynamic parameters were also tested. Results The level of plasma BNP in acute STEMI group was obviously higher than that in NSTEACS group（ 188.46 ± 222.03 vs. 37.91 ± 52.35, P = 0. 001 ）. According to the comparison between STEMI and NSTEACS, there were no apparent differences （ P 〉 0.05） among the left ventricular end - diastolic dimension （LVEDD）, the left ventricular end- systolic dimension （LVESD）, the left atrium dimension and the left ventricular ejection fraction（LVEF）. BNP showed a negative relationship with left ventricular ejection fraction（ r = - 0. 393, P 〈 0.05）, and a positive relationship with LVEDD, LVESD（ r = 0.415 and 0.421, P 〈 0.05）. Plasma BNP level, cTnI level and left ventricular ejection fraction closely correlated with the severity of acute coronary syndromes （OR：2.640,2.782,2.036） .Conclusions Plasma BNP level may be a peculiar indicator for monitoring acute coronary syndrome patient, and an independent indicator for predicting early risk stratification in acute coronary syndrome.