急性冠脉综合征中血氨基末端脑钠素前体水平变化趋势

Study on the N-terminal pro-brain natriuretic peptide level in acute coronary syndrome

目的观察急性冠脉综合征(ACS)中不同病情患者的血氨基末端脑钠素前体(NT-proBNP)水平变化趋势。方法选择52例发病24 h以内的ACS患者,分为ST抬高的急性心肌梗死(STEAMI)组、无ST抬高的急性心肌梗死(NSTEAMI)组和不稳定型心绞痛(USAP)组。10例稳定型心绞痛患者为SAP组。患者既往均无明显心功能不全临床表现。于入院即刻、入院后24 h及1周测定NT-proBNP、高敏C反应蛋白(Hs-CRP),入院后7～10 d查超声心动图。结果STEAMI和NSTEAMI组的NT-proBNP峰值均高于临界值,高峰见于人院后24 h内。USAP和SAP组的NT-proBNP峰值高于临界值的比例分别为80%和20%。剔除行急诊经皮冠状动脉介入治疗(PCI)的急性心肌梗死患者后,NT-proBNP峰值与肌酸激酶(CK)及CK同工酶(CK—MB)峰值呈显著正相关(r值分别=0．511、0．528,P值均=0．002)。而与左室射血分数值、左室舒张末期直径、左房直径及Gensini积分均不相关。KilliⅡ～Ⅳ级者的血NT-proBNP峰值均明显高于KillipⅠ级者(P＜0．01)。行急诊PCI治疗的急性心肌梗死患者1周后的血NT-proBNP降幅明显高于未行PCI者,而血NT-proBNP/CK—MB峰值明显降低。结论ACS时血NT-proBNP值的升高是心肌细胞急性缺血时的一种反应,并且其升高程度与梗死面积有关。但对于急性心肌梗死并发心功能不全者,NT-proBNP值升高更明显。

Objective To observe the N-terminal pro-brain natriuretic peptide （NT-proBNP） level in acute coronary syndrome patients with different status. Methods 52 patients enrolled in this study had acute coronary syndrome within 24 hours after onset were divided into three groups （ST-elevation AMI, Non ST-elevation AMI and unstable angina）. Another 10 stable angina patients constituted SAP group. All patients had no history of heart failure. NT-proBNP and highly sensitive C reactive protein were determined at 0 h, 24 h and 1 week after admission, and echocardiogram was also performed during the 7th to 10th day of hospitalization. Results NT-proBNP level was high in all acute myocardial infarction patients, it increased rapidly to the peak at 24 h. High NT- proBNP level was also demonstrated in 80%0 unstable angina patients and 20%0 stable angina patients. In AMI patients without emergency percutaneous coronary interventional （PCI） therapy, the peak NT-proBNP level was positively correlated with peak creatine kinase（CK） and peak creatine kinase MB（CK-MB） which reflected the infarcted area （CK： r = 0. 511, P = 0. 002; CK-MB： r =0. 528, P = 0. 002）, but was not correlated with left ventricular ejection fraction, left ventricular diastolic terminal and atrial diameters which reflected heart function in all AMI cases, and it also had no correlationship with Gensini scoring which reflected the severity of coronary artery disease. The NT-proBNP level was higher in Killip Ⅱ AMI patients than in Killip Ⅰ patients（P 〈 0.01）. After one week, the NT-proBNP level decreased more quickly in emergency PCI patients than that in the other acute myocardial infarction patients, and the peak blood NT-proBNP/peak CK-MB ratio of emergency PCI patients was also lower than that in the others. Conclusion Increment of plasma NT-proBNP level is a reaction of ischemic myocardial cells in acute coronary syndrome, and it is correlated with the infarct area. But NT-proBNP level is much higher in heart failure complicating AMI patients. （Shanghai Med J, 2006, 29：621-624）