急性冠脉综合征患者氨基末端脑钠肽前体水平检测及临床意义分析

Study on Detection and Clinical Significance of the Plasma Level of NT-proBNP in Patients with Acute Coronary Syndrome

目的探讨急性冠脉综合征(ACS)患者血浆氨基末端脑钠肽前体(NT-proBNP)水平及其临床意义。方法选取临床上诊断为ACS的患者322例,其中急性心肌梗死(AM I)患者207例(AM I组包括ST段抬高性心肌梗死和非ST段抬高性心肌梗死),不稳定心绞痛(UA)患者115例(UA组);同时选取冠状动脉造影正常者45例作为正常对照组。检测血浆NT-proBNP及肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)水平。彩色超声心动图检测其左室射血分数(LVEF)。结果 (1)AM I组NT-proBNP水平为897.6[219.4～1918.5]pg/m l,明显高于UA组的182.1[84.9～596.2]pg/m l,且两组患者NT-proBNP水平均明显高于正常对照组的117.7[66.6～213.2]pg/m l,差异均有统计学意义(P<0.05)。(2)NT-proBNP与hs-CRP、cTnT呈正相关(r=0.451,P=0.000;r=0.183,P=0.001),与LVEF呈负相关(r=-0.423,P=0.000)。(3)不同冠状动脉病变程度者NT-proBNP水平间差异有统计学意义(P<0.001)。结论 NT-proBNP可以作为心肌缺血范围和严重程度以及左心室功能受损的指标,测定ACS患者的NT-proBNP水平,有助于对该类患者进行早期危险分层,指导临床治疗方案的制定。

Objective To discuss the plasma level and clinical significance of NT-proBNP in Patients with Acute Coronary Syndrome（ACS）.Methods 322 patients with ACS were selected,among which 207 cases in acute myocardial infarction（AMI） group（including ST elevation myocardial infarction and non-ST elevation myocardial infarction）,115 cases in unstable angina pectoris（UAP） group,and 45 cases in normal control group.Plasma level of NT-proBNP,cTnT and hs-CRP were detected,and LVEF was tested by ultrasonic cardiography.Results ①AMI patients had significantly higher NT-proBNP levels（897.6[219.4～1918.5]pg/ml） than UAP group（182.1[84.9～596.2]）（P0.05）.Both of the two groups had significantly higher NT-proBNP levels than normal control group（117.7[66.6～213.2]pg/ml）（P0.05）.② The plasma level of NT-proBNP was positively correlated with hs-CRP（r=0.451,P=0.000）and cTnT（r=0.183,P=0.001）,and negatively correlated with LVEF（r=-0.423,P=0.000）.③ The plasma level of NT-proBNP was significantly positively correlated with the lesion of coronary artery（P0.001）.Conclusion NT-proBNP can be an index judging the range and severity of ischemia myocardial and impaired left ventricle.Detecting plasma level of NT-proBNP in ACS patients can be beneficial in the early risk stratification and clinical therapy.