血浆脑钠肽在急性冠状动脉综合征中的意义

Significance of B-type natriuretic peptide in acute coronary syndrome.

目的研究脑钠肽（BNP）在急性冠状动脉综合征（ACS）中的临床意义。方法选择2006年5月至2008年6月间我院住院的急性冠状动脉综合征患者151例，同期住院的高血压患者212例为对照组。均常规检测血脂、血糖、血常规、肾功能、超敏C-反应蛋白、脑钠肽（BNP）；并记录患者血压、心率、吸烟史及高血压、糖尿病、高血脂等病史；同时检测常规心脏超声。结果ACS组与对照组在年龄[（69．0±10．9）与（62．0±14．2）岁，t=5．043，P〈0．001]、血肌酐[（95．0±67．4）与（72．8±29．0）μmol／L，t=4．164，P〈0．001]、血尿酸[（360．2±104．4）与（300．8±92．7）μmol／L，t=5．521，P〈0．001]、BNP（80．81与352．38ng／L,Z=-7．295，P〈0．001）、hs-CRP（7．99与17．08mg／L，Z=-3．983，P〈0．001）、外周血[WBC（7．843±3．025）×10^9’／L与（6．333±3．569）×10^9／L，t=4．209，P〈0．001]、单核细胞[（0．522±0．201）×100／L与（0．417±0．157）×10^9／L，t=5．084，P〈0．001]、血糖[（6．518±2．303）与（5．691±2．085）mmol／L，t=3．461，P=0．001]、收缩压[（134．7±27．8）与（142．0±26．3）mmHg，t=2．536，P=0．012]等指标差异均有统计学意义。2组间吸烟比例[43．7％（66／151）和23．1％（49／212），χ^2=17．283，P〈0．001]、男性比例[74．8％（113／151）和48．6％（103／212），χ^2=25．217，P〈0．001]差异亦有统计学意义。经过多因素回归分析发现：年龄（χ^2=10．369，P=0．001）、性别（χ^2=12．836，P〈0．001）、BNP（χ^2=4．807，P=0．028）、WBC（χ^2=10．788，P=0．001）是造成2组间差异的主要原因。在ACS组，BNP与患者的左心室射血分数值之间存在线性关系（t=5．789，P〈0．001）。结论高龄、男性、外周血WBC和BNP与ACS存在密切关系，而BNP更对ACS患者的预后具有一定的预测价值。

Objective To investigate the significance of B-type natriuretic peptide （BNP） in acute coronary syndrome（ACS）. Methods 151 in-patients of ACS during May 2006 to June 2008 were selected as the treatment group. Other 212 impatients with essential hypertension were selected as control group. Blood lipid, blood glucose ,blood routine, renal function,high sensitive C-reaction protein （hs-CRP） and BNP were examined in all patients. Their blood pressure, heart rate, and history of smoking, hypertension, diabetes mellitus and hyperlipidemia were recorded. All patients underwent uhrasonography. Results Between the two groups, age （ 69. 0 ± 10. 9 与 62.0 ± 14.2,t = 5. 043, P 〈 0.001 ）, blood creatinine [ （ 95.0 ± 67.4 ） vs. （72.8 ± 29. 0） μmol/L, t = 4. 164, P 〈 0.001） ,blood uric acid[ （360.2 ± 104.4） vs. （300.8 ±92.7） μmol/L, t =5. 521 ,P 〈0. 001 ], BNP（80.81 vs. 352.38 ng/L,Z = - 7. 295, P 〈 0. 001 ）, hs-CRP （7.99 vs. 17.08, Z = - 3. 983, P 〈 0. 001 ）, white blood cells （WBC） [ （7. 843 μ 3. 025 ） × 10^9/L vs. （ 6. 333 ± 3. 569 ） × 10^9/L, t = 4. 209, P 〈 0. 001 ], monocytes [ （ 0. 522 ± 0. 201 ） × 10^9/L vs. （0.417 ± 0. 157 ） × 10^9/L, t = 5. 084, P 〈 0. 001 ] and blood glucose [ （6.518 ± 2. 303 ） vs. （5. 691 ± 2. 085 ） mmol/L, t = 3. 461, P = 0. 001 ] had significant difference. Systolic blood pressure had difference between two groups [ （ 134.7 ± 27.8 ） vs. （ 142.0 ± 26.3 ） mm Hg, t = 2. 536, P = 0. 012 ]. However, the percentage of smoking [ 43.7 % （66/151 ）vs. 23.1% （49/212 ）, χ^2 = 17. 283, P 〈 0.001 ] and male gender [ 74.8 % （ 113/151 ） vs. 48.6% （ 103/212）, χ^2 = 25. 217, P 〈 0.001 ） ] had significant difference between two groups（ P 〈 0. 001 ）. Muhivariable regression analysis showed that age （ χ^2 = 10. 369, P = 0. 001 ）, gender （ χ^2 = 12. 836, P 〈 0. 001 ）, BNP （χ^2 =4. 807 ,P =0.028） and WBC（χ^2 = 10. 788 ,P =0. 001 ） were the main factors of difference between the two groups. Moreover, BNP was linearly correlated with left ventricular ejection fraction （EF） in ACS patients （ t = 5. 789 ,P 〈0.001 ）. Conclusion Old age ,male ,WBC and BNP are closely related with ACS ,of which BNP has certain predictive value for ACS.