急性心肌梗死患者B型利钠肽检测及临床意义

B-type Natriuretic Peptide for Prognosis after Acute Myocardial Infarction

目的探讨B型利钠肽(BNP)与肌钙蛋白I(cTnI)对急性心肌梗死(AMI)患者的预后价值。方法采用竞争酶联免疫法和化学发光法分别测定入院即刻及发病第七天BNP和cTnI水平,记录主要心血管事件(MACE)的发生率。分析BNP和cTnI水平与发生MACE的相关性。结果AMI患者入院即刻BNP水平明显高于对照组(P<0.01);发病时间>10 h入院的AMI患者BNP水平明显高于发病时间≤10 h者(P<0.01);入院一周内死亡患者的BNP水平明显高于一周存活者(P<0.05)。发生MACE的患者BNP水平明显高于未发生者(P<0.01);AMI患者发病第七天BNP水平(432.79±383.82 pg/mL)明显高于对照组(P<0.01);第七天BNP≥432.79 pg/mL的AMI患者总MACE发生率明显高于BNP<432.79 pg/mL者(P<0.01)。入院即刻cTnI≥52.5 ng/mL者总MACE发生率明显高于cTnI<52.5 ng/mL者(P<0.01)。联合入院即刻及发病第七天BNP和cTnI检测,两者均阳性者MACE发生率明显升高(P<0.05)。结论①入院即刻及发病第七天BNP水平具有预测预后的价值;②BNP水平越高,发生MACE危险性越高;③联合BNP、cTnI检测可进一步提高BNP对AMI患者的预测预后价值。

Objective To investigate the prognostic value of the plasma levels of B-type natriuretic peptide（BNP） and cardiac troponin I（cTnI） in patients with acute myocardial infarction. Methods BNP and cTnI levels at admission and the seventh day after infarction were measured by enzyme--linked immunosorbent assay（ELISA） and chemoluminescence technique. Major cardiovascular events（MACE）were recorded. Correlation between the cTnI and BNP levels and the incidence of MACE were analyzed. Results The plasma levels of BNP were significantly increased on admission in patients with AMI compared with controls （P〈0. 01）;The levels in patients who hospitalized after 10 hours of AMI onset were higher than those within 10 hours（P〈0.01）;and in patients who died within a week after admission, the levels were much higher than those in survival patients（P〈0. 01）. Patients with elevated BNP plasma levels were at higher risk of MACE （P〈0.01）;the incidence of MACE in BNP positive group was much higher than those in BNP negative group（P= 0. 044）. Compared with controls, BNP concentrations in patients at the seventh day after infarction were much higher（432.79 ± 383.82pg/ml versus 48.45 ± 18.35pg/ ml,P〈0.01） ;MACE incidence in patients with cTnI levles≥52.5 ng/mL was much higher than those in patients with cTnI levles 〈52.5 ng/mL at admission instantly （P〈0.01）. In patients with higher BNP and cTnI concentration at admission instantly, the incidence of MACE increased significantly. Conclusions BNP obtained at admission and the seventh day after the onset of AMI,provide powerful information for use in predicting prognosis, he higher BNP level is, the higher hazard of the incidence MACE is. BNP associating with cTnI can increase prognostic value in patients with AMI.