氨基端脑钠肽原与细胞分化抗原40配体联合预测急性冠脉综合征近期预后

Prognostic value of N-terminal pro-brain natriuretic peptide combined with soluble CD40L in acute coronary syndrome patients

目的探讨联合血浆氨基端（N端）脑钠肽原（NT-proBNP）与可溶性细胞分化抗原40配体（sCD40L）共同预测急性冠脉综合征（ACS）患者的近期预后的价值。方法研究134例ACS患者，其中ST段抬高心肌梗死70例，非ST段抬高心肌梗死8例，不稳定型心绞痛56例，应用ELISA法分别在发病12～24h之内测定血浆NT-proBNP和scD40L浓度，根据NTproBNP浓度的ROc曲线确定分界值（1163．89pmol／L），分为高NT-proBNP组和低NT-proBNP组，根据测得sCD40L浓度的ROC曲线确定分界值（915ug／L），分为高sCD40L组和低sCD40L组，再将NT-proBNP与sCD40L联合分组，分为阳性组（NT-proBNP和sCD40L均为高浓度组），弱阳性组（NT-proBNP和sCD40L仅有一项为高浓度组），阴性组（NT-proBNP和sCD40L均为低浓度组），并随访[平均（96．62土9．08）d]主要不良心脏事件（MACE）。结果高NT～proBNP组41例，MACE发生率48．8％（20例），低NT-proBNP组93例，MACE发生率4．3％（4例），两组间MACE的发生率有统计学显著性差异；高sCD40L组57例，MACE发生率28．1％（16例），低sCD40L组77例，MACE发生率10．4％（8例），两组间统计学差异有显著性意义；联合NT-proBNP与sCD40L共同预测ACS预后，阳性组23例，MACE发生率为56．5％（13／23），弱阳性组52例，MACE发生率19．2％（10／52），阴性组59例，MACE发生率为1．7％（1／59），3组之间统计学差异有显著性意义。结论联合血浆NT-proBNP与sCD40L提高了对ACS患者近期预后的预测价值。

Objective To investigate the prognostic value of N-terminal pro-brain natriuretic peptide （NT- proBNP） combined with soluble CD40 ligand （sCD40L） in acute coronary syndrome （ACS） patients. Methods A total of 134 ACS patients were enrolled ; seventy patients with ST elevation myocardial infarction, 8 patients with nonST elevation myocardial infarction, and 56 patients with unstable angina. Plasma NT-proBNP and sCD40L were measured by ELISA obtained between 12-24h after admission. According to the ROC curve, the cut-off vaiue of NTproBNP and sCD40L was 1 163.89 pmol/L and 915μg/L respectively. And, according to NT-proBNP combined with sCD40L results the patients were divided into 3 groups. In addition, the patients with ACS were evaluated during the in-hospital period and followed-up for （96.62±9.08）d for major adverse cardiac events （MACE）. Results The incidence of MACE was significantly higher in high concentration （n=41） than that in low concentration of NT-proBNP group（n= 93） （48, 8 % vs 4.3 %, P〈0. 01）. The incidence of MACE was higher in high concentration sCD40L group （n：57） than that in low concentration one （n=77） （28. 1% vs 10.4%,P〈0.01）. The morbidity of MACE was 56.5 %, 19, 20%and 1.7 %, respectively, in positive group （high concentration o5 both NT-proBNP and sCD40L）, weakly positive group （one marker with high concentration）, and negative group （with low concentration of both markers）. Conclusion The combination of NT-proBNP and sCD40L adds critical prognostic insight to the assessment of patients with ACS.