B型脑钠肽在评估非ST段抬高急性冠脉综合征患者预后中的价值

Plasma B-type Natriuretic Peptide in Patients With Non-ST Elevation Acute Coronary Syndrome

目的:目前急性冠脉综合征中ST段抬高心肌梗死患者B型脑钠肽水平增高及意义已得到广泛的认同,但对于非ST段抬高心肌梗死(Non-ST elevation myocardial infarction,NSTEMI)和不稳定性心绞痛(Unstable angina,UA)患者B型脑钠肽的变化及差别尚不肯定。本文通过分析其规律及与近期心血管事件的关系,用于危险分层评估。方法:入选急性冠脉综合征患者138例,其中NSTEMI组69例,UA组69例,同时入选胸痛就诊但冠状动脉造影正常的患者30例作为对照组。所有患者于发病6小时从周围静脉中留取血样测定B型脑钠肽,同期测定全血肌钙蛋白I。随访3个月内主要不良心血管事件的发生率。结果:①NSTEMI组、UA组、对照组B型脑钠肽水平分别为34.9pg/ml(四分位区间为18.20pg/ml至81.85pg/ml)、13.9pg/ml(四分位区间为8.00pg/ml至26.45pg/ml)和9.4pg/ml(四分位区间为5.00pg/ml至12.6pg/ml),3组之间比较差异有统计学意义,P<0.05。NSTEMI组B型脑钠肽水平最高,并且与全血肌钙蛋白I水平呈正相关(r=0.675,P<0.001)。②随访3个月,138例中有30例患者(21.7%)发生主要不良心血管事件,发生者B型脑钠肽水平高于未发生者(31.3pg/ml vs 19.35pg/ml),P=0.001。结论:非ST段抬高急性冠脉综合征患者早期B型脑钠肽水平明显升高,并且B型脑钠肽水平与近期心血管事件的发生有一定相关性,可应用于危险分层的评估。

Objective： To evaluate B-type natriuretic peptide （BNP） levels in patients with non-ST-elevation acute coronary syndrome （NSTE-ACS） and its relationship with the risk factor of major adverse cardiovascular events. Methods： 138 consecutive patients with NSTE-ACS including 69 Non-ST elevation myocardial infarction （NSTEMI） and 69 unstable angina （UA） were studied. 30 chest pain patients were enrolled as Control group and the coronary heart disease was excluded by angography. BNP concentration and troponin I （TNI） level were examined at 6 hours of onset. All patients were followed up for 3 months for major adverse cardiovascular events （MACE） including heart failure, recurrent angina peetoris, and cardiac death. Results： BNP levels were higher in NSTEMI group than UA group and Control group respectively （34. 9pg/ml vs. 13.9 pg/ ml vs. 9.4 pg/ml ,P 〈0. 001 ）. There was a significant correlation between BNP and TNI in patients with NSTEMI （ r = 0. 675, P 〈0. 001 ）. There were 30 （21.7%） patients suffered from MACE during the follow up period of time. BNP levels were significandy higher in MACE patients. Conclusion ： BNP level was higher in the early stage in patiewts with of NSTE-ACS. BNP level might be a biochemical marker of risk factor and prognosis indicator in patients with NSTE-ACS.