B型钠尿肽、心肌肌钙蛋白Ⅰ和高敏C反应蛋白在急性冠状动脉综合征中联合应用的研究

Research on the combined determination of B-type natriuretic peptide,cardiac troponin Ⅰ and high sensitive C reactive protein in acute coronary syndrome

目的探讨B型钠尿肽(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)、高敏C反应蛋白(hs-CRP)三者的联合应用对于评估急性冠状动脉综合征(ACS)患者不良心血管事件(MACE)发生及预后的价值。方法检测131例ACS患者血浆BNP、hs-CRP及cTnⅠ水平,并对出院患者随访1年,将其分为MACE发生组[MACE(+)]与未发生组[MACE(-)],观察3项指标与MACE发生的关系。按3项指标不同升高数将患者分为0、1、2和3个指标升高4组,用Kaplan-Meier法做生存曲线分析,以了解指标升高数与生存率的关系。并对患者年龄、性别、左室射血分数(LVEF)、是否吸烟、糖尿病、高血压、高血脂等因素做多因素Cox比例风险回归模型分析。结果131例ACS患者中,随访1年内MACE(+)患者BNP、hs-CRP水平显著高于MACE(-)的患者(P<0.01);cTnⅠ阳性率在MACE(+)和MACE(-)间无差异。按指标不同升高数分组的4组其生存曲线间生存率的差异有统计学意义(P<0.01)。多因素Cox比例风险模型发现LVEF[P=0.004,比值比(OR)=0.939]与hs-CRP(P=0.012,OR=1.026)是患者预后生存的危险因素。结论BNP、hs-CRP与ACS患者1年内MACE发生有关,而cTnⅠ阳性率与MACE发生无关。3个指标升高数目不同的4组ACS患者间生存率不同,因此三者联合检测对ACS患者1年内MACE的发生与否及1年内的生存率的评估有更好的预测价值。

Objective To evaluate the occurrence of major adverse cardiovascular events（MACE） and prognostic value of B-type natriuretic peptide（BNP）,cardiac troponin Ⅰ（cTnⅠ） and high sensitive C reactive protein（hs-CRP）in patients with acute coronary syndrome（ACS）.Methods The plasma levels of BNP,hs-CRP and cTnⅠ in 131 patients with ACS were determined.The patients were followed up 1 year after discharge.The 131 patients were classified into 2 groups [MACE（＋） and MACE（-）].The relationship of the 3 markers with the MACE was observed.The patients were classified into 4 groups according to the different levels of the 3 markers.They were 0 marker elevated group,1 marker elevated group,2 markers elevated group and 3 markers elevated group.Kaplan-Meier survival curve analysis was used to analyze the relationship of survival rate with the numbers of elevated markers.The factors of patient′s age,sex,left ventricular ejection fraction（LVEF） and whether or not had smoking,diabetes,high blood pressure and high cholesterol were analyzed by multivariate Cox proportional hazards regression model analysis.Results Among 131 patients with ACS,the levels of BNP and hs-CRP in MACE（＋） were significantly higher than those in MACE（-）（P0.01）,but the positive rate of cTnI had no difference in the 2 groups.According to the increased number of markers,the survival rate of the 4 survival curves had statistical significance（P0.01）.By multivariate Cox proportional hazards regression model analysis,LVEF [P=0.004,odds ratio（OR）=0.939] and hs-CRP（P=0.012,OR=1.026）were the risk factors of patients in survival prognosis.Conclusions BNP,hs-CRP in patients with ACS are related to the occurrence of MACE within 1 year,but the positive rate of cTnI is not related to the occurrence of MACE.The 4 groups with different elevated numbers of 3 markers have different survival rates,so the combined determination of 3 markers is very useful for the information of the occurrence of MACE and the survival rate in patients with ACS in 1 year.