血浆和肽素与急性心肌梗死患者近期预后的关系

Relationship of plasma Copeptin and short-term prognosis of patients with acute myocardial infarction

目的:探讨血浆和肽素和肌钙蛋白I(cTnI)在急性心肌梗死(AMI)患者中的关系及对其近期预后的预测价值。方法:选择因胸痛(发病时间<24h)入院诊断为AMI患者97例,冠状动脉造影正常者30例为对照组。采用ELISA法测定血浆和肽素浓度,采用免疫荧光定量技术测定cTnI浓度,连续测定3d和肽素和cTnI水平。记录患者住院和平均随访6个月期间的心血管事件(心血管死亡、心力衰竭、再发心绞痛或再发心肌梗死)的发生情况。结果:AMI组和肽素浓度高于对照组(17.68vs 3.51pmol/L,P<0.05);发病第1天和肽素水平高于第3天(17.68vs 6.46pmol/L,P<0.05),尤以发病0～3h升高最明显;AMI组cTnI与和肽素浓度呈负相关;发生心血管事件组和肽素水平高于未发生心血管事件组,多变量logistic逐步回归表明发病第3天和肽素水平是预测近期心血管事件的危险因素(OR=1.315,95%CI:1.171～1.475,P<0.05)。结论:和肽素与cTnI之间呈负相关,发病第3天和肽素水平是预测近期心血管事件的有效指标之一。

Objective：To explore the correlation between C-terminal portion of provasopressin（Copeptin） and cardiac troponin I（cTnI） in patients with acute myocardial infarction and the short-term prognosis value of Copeptin. Method：We selected 97 subjects who had acute myocardial infarction（AMI） with onset 24 h in our study,with follow-up average 6 months,and 30 normal coronary angiography（CAG） as control group.The plasma Copeptin were measured by enzyme-linked immunosorbent assay（ELISA）;the plasma cTnI were measured by immunofluorometric assay technique.Copeptin and cTnI were measured daily for 3 days.The clinical main adverse cardiac events（MACE） including cardiac death,heart failure,myocardial infarction or recurrent angina pectoris were recorded during hospitalization and follow-up. Result：Compared with control subjects,level of Copeptin and cTnI were higher in patients with AMI（P0.05）.The admission plasma levels of Copeptin in AMI were higher than the third day [（17.68 vs 6.46）pmol/L,P0.05],especially the 0~3 h plasma levels of Copeptin were more higher.Negative correlations between Copeptin and cTnI were observed by Spearman correlations analysis.In the AMI patients,Copeptin level was elevated in patients with MACE compared with patients without MACE.Multivariate logistic regression analysis revealed that the third day Copeptin level was independently associated with MACE during average 6 months（odds ratio： 1.315,95% confidence interval： 1.171～1.475,P0.05）. Conclusion：There is negative correlation between the level of Copeptin and cTnI of patients with AMI.The third day plasma level of Copeptin is associated with short-term prognosis in patients with AMI.