N-端脑钠素前体在急性冠状动脉综合征患者急诊支架置入术的变化

Changes of N-terminal pro-brain natriuretic peptide levels before and after percutaneous coronary intervention in patients with acute coronary syndrome

目的:探讨急性冠状动脉综合征患者支架置入术前、后N-端脑钠素前体(N-terminal pro-brain natriureticpeptide,NT-proBNP)水平的变化及临床意义。方法:急诊行冠状动脉支架置入术的急性冠状动脉综合征患者99例,其中急性心肌梗死组56例,不稳定性心绞痛组43例。检测患者术前、术后即刻及术后7 d NT-proBNP水平,观察对术后3个月主要不良心血管事件的影响。结果:急性心肌梗死组与不稳定性心绞痛组NT-proBNP水平术前分别为(776.8±219.2)pg/mL与(351.2±123.4)pg/mL(P<0.01),术后即刻分别为(963.6±315.3)pg/mL与(372.5±142.1)pg/mL(P<0.01),术后7 d分别为(443.7±188.5)pg/mL与(275.6±98.2)pg/mL(P<0.01);术后即刻NT-proBNP水平均高于术前,但仅急性心肌梗死组与术前比较差异有统计学意义(P<0.05),术后7 d NT-proBNP水平较术前及术后即刻均降低(P<0.05),且急性心肌梗死组较不稳定性心绞痛组下降趋势更明显。基线NT-proBNP≥300 pg/mL患者术后3个月发生主要不良心血管事件率10.6%(7/66)高于NT-proBNP<300 pg/mL患者的6.1%(2/33)(P<0.05)。结论:急性冠状动脉综合征患者支架置入术前、后NT-proBNP水平存在动态改变,并与疾病严重程度及预后相关。

Objective To investigate the changes and the significance of N-terminal pro-brain natriuretic peptide levels before and after percutaneous coronary intervention in patients with acute coronary syndrome.Methods Ninety-nine cases of acute coronary syndrome were divided into acute myocardial infarction group（n=56） and unstable angina group（n=43）.All cases were performed percutaneous coronary intervention.N-terminal pro-brain natriuretic peptide level was detected in all cases before coronary angiography,immediately and 7 days later after percutaneous coronary intervention.The influence of N-terminal pro-brain natriuretic peptide on the main adverse cardiovascular events were observed in postoperative three months in all cases.Results N-terminal pro-brain natriuretic peptide levels were（776.8±219.2） pg/mL and（351.2±123.4） pg/mL before coronary angiography,（963.6±315.3） pg/mL and（372.5±142.1） pg/mL immediately after percutaneous coronary intervention,and were（443.7±188.5） pg/mL and（275.6±98.2） pg/mL 7 days after percutaneous coronary intervention in acute myocardial infarction and unstable angina group respectively（P〈0.01）.N-terminal pro-brain natriuretic peptide level was higher immediately after percutaneous coronary intervention than that before in both groups,which showed a significant difference in acute myocardial infarction group（P〈0.05）.N-terminal pro-brain natriuretic peptide level was lower 7 days after percutaneous coronary intervention than that immediately after percutaneous coronary intervention in both groups（P〈0.05）,which was more obvious in the acute myocardial infarction group.The main adverse cardiovascular events rate was 10.6%（7/66） when the baseline of N-terminal pro-brain natriuretic peptide was over 300 pg/mL,and was 6.1%（2/33） when it was lower than 300 pg/mL（P〈0.05）.Conclusion N-terminal pro-brain natriuretic peptide level changes dynamically in patients with acute coronary syndrome after percutaneous coronary intervention,and is correlated with the disease severity and the prognosis.