血浆B型利钠肽水平对非ST段抬高性急性冠脉综合征患者预后的预测价值

Relation of plasma brain natriuretic peptide levels on admission to prognosis in patients with non-ST segment elevation acute coronary syndrome

目的评估血浆B型利钠肽(BNP)水平对非ST段抬高性急性冠脉综合征(NSTE-ACS)患者预后的预测价值。方法入选NSTE-ACS患者180例,所有患者于发病第24小时采用免疫荧光法测定血浆BNP水平,根据24 hBNP水平将患者分为血浆BNP≥80 ng/L组与BNP<80 ng/L组。对所有患者随访6个月,观察早期BNP水平与随访6个月主要不良心血管事件发生的关系。结果随访6个月,180例患者中有42例(23%)患者发生主要不良心血管事件,血浆BNP≥80 ng/L组患者主要不良心血管事件发生率明显高于BNP<80 ng/L组患者(P=0.003),在校正了年龄、性别、高血压病、糖尿病、高脂血症、吸烟及左室射血分数等影响预后的危险因素后,NSTE-ACS患者入院早期血浆BNP水平≥80 ng/L与随访6个月发生主要不良心血管事件显著相关[校正RR=3.625,95%CI(1.505～8.731),P=0.004]。结论 NSTE-ACS患者早期BNP水平增高有助于评价NSTE-ACS患者6个月主要不良心血管事件的发生,可应用于危险分层的评估。

Objective To investigate the relation between brain natriuretic peptide（BNP） levels on the first 24 hours after the onset of non-ST segment elevation acute coronary syndrome and the major adverse cardiovascular events（MACEs-ACS） 6 months later.MethodsConsecutive 180 patients with non-ST segment elevation acute coronary syndrome were studied,BNP plasma concentration levels were measured by fluorescence immunoassay at 24 hour from onset,patients were divided into two groups according to plasma BNP level,group A： BNP≥80 ng/L;group B：BNP80 ng/L.All patients were followed for 6 months.ResultsForty two patients suffered from MACEs at 6 months.the incidences of MACEs were more higher in group A than in group B（P=0.003）,after adjusting for age,sex,hypertension,diabetes mellitus,smoking status,left ventricular ejection fraction,the elevated BNP levels（≥80 ng/L） were significantly associated with subsequent MACEs（adjusted relative risk [RR=3.625,95%CI（1.505～8.731）,P=0.004].ConclusionElevated BNP levels（≥80 ng/L） on admission in patients with NSTE-ACS may be helpful assessing MACEs at 6 months later,may help guide risk stratification in patients with NSTE-ACS.