B型钠尿肽在急性冠脉综合征患者早期诊断中的应用

Use of plasma B-type natriuretic peptide levels in evaluation of patients with acute coronary syndrome

目的:分析急性冠脉综合征(ACS)患者早期B型钠尿肽(BNP)水平的差异,评估BNP在早期诊断中的作用。方法:入选末次症状发作至就诊时间均<6h的ACS患者221例,分为ST段抬高心肌梗死(STEMI)组(n=83)、非ST段抬高心肌梗死(NSTEMI)组(n=69)和不稳定性心绞痛(UA)组(n=69)。所有患者在入院即刻测定BNP水平,发病12h内测定肌钙蛋白I(TnI),比较不同组间BNP的差别及BNP与TnI的相关性。结果:UA、NSTEMI和STEMI患者基础血浆BNP浓度依次升高(分别为13.9pg/ml、34.9pg/ml和64.2pg/ml)(组间比较P<0.01),且STEMI和NSTEMI患者BNP水平与TnI正相关(!分别为0.724和0.675,P均<0.01)。BNP≥100pg/ml对NSTEMI诊断阳性预测值达83.3%。结论:ACS患者早期BNP水平升高,对早期鉴别NSTEMI和UA有一定价值。

Objective：To evaluate the diagnostic value of B-type natriuretic peptide （BNP）in patients with acute coronary syndrome （ACS）.Methods：Two hundred and twenty one patients with ACS were recruited whose latest onset time was within 6 hours.In them 83 patients had ST elevation myocardial infaretion（STEMI）,69 patients had non-ST elevation myocardial infaretion（NSTEMI）and 69 patients had unstable angina（UA）.Blood samples for BNP were drawn at admission.Results：A significant increase in BNP levels was observed in STEMI （64.2pg/ml） compared with the other groups. NSTEMI had higher BNP levels than UA（34.9pg/ml vs 13.9pg/ml, P〈0.01）. There was a significant correlation between BNP and troponin Ⅰ（TnⅠ） level in patients of STEMI and NSTEMI （γ=0.724 and 0.675, P〈0.01）.The positive predictive value of BNP≥ 100pg/ml in NSTEMI was 83.3%. Conclusion：BNP levels were increased significantly in patients with ACS and may be a useful adjunctive marker to diagnosis in patients suspected with ACS.