B型脑钠肽在初发急性心肌梗死患者危险分层和短期临床预后中的作用

B-type natriuretic peptide testing on risk stratification and short-term prognosis evaluation in patients with first acute myocardial infarction

目的分析初发急性心肌梗死(AMI)患者血浆B型脑钠肽(BNP)水平与梗死面积及住院期间和随访3个月的主要不良心脏事件(MACE)之间的关系,评价BNP在AMI患者的危险分层和短期预后中的意义。方法选取非心力衰竭初发AMI患者82例,按照心电图分为ST段抬高型心肌梗死(STEMI)组和非ST段抬高型心肌梗死(NSTEMI)组,比较各组BNP水平;并按照BNP水平分为BNP<100ng/L组,BNP≥100～200ng/L组和BNP≥200ng/L组,比较各组MACE的发生率。结果 STEMI组血浆BNP水平显著高于NSTEMI组,(208.4±180.2)ng/Lvs(93.6±76.8)ng/L(P<0.01)。BNP≥200ng/L组MACE发生率高于BNP≥100～200ng/L组和BNP<100ng/L组(分别为46.2%,8.33%,3.12%;P<0.01)。BNP与住院期间和短期MACE发生相关(HR=0.985,95%可信区间CI=0.973～0.996;P<0.01)。结论 AMI患者的BNP水平越高,梗死面积越大,近期MACE发生率越高,高BNP水平是与住院期间和短期MACE发生率相关的危险因素。BNP测定有助于AMI患者的危险分层及预后判断。

Objective To explore the relationship between infarction area, major adverse cardiac events （MACE） in hospital and follow-up for 3 months with plama B-type natriuretic peptide （BNP） levels in patients with first acute myocardial infarction（AMI）. To assess the value of BNP on risk stratification and prognosis in patients with AMI. Methods 82 AMI patients without heart failure（HF） were enrolled in the study. They were divided into ST elevated myocardial infarction（STEMI） group and non- ST elevated myocardial infarction（NSTEMI） group according to ECG manifestations. By comparison in BNP levels, the patients were divided into three groups, BNPG 100 ng/L group,BNP≥100-200 ng/L group and BNP≥200 ng/L group. Comparison was made on the incidences of MACE. Results The plasma BNP concentrations in patients with STEMI were significantly higher tlhan those in NSTEMI, （208.4±180.2） ng/L vs （93.6±76.8） ng/L （ P G0.01）. The incidences of MACE were increased with the higher plasma BNP （3.12% for BNP 〈100 ng/L,8.33% for BNP 100--200 ng/L,46.2% for BNP ≥200 ng/L, P G0.01）. Conclusion In AMI patients without heart failure,the higher the plasma BNP,the more infarction area,and the more MACE while in hospital and short-term after AMI. BNP testing is valuable in risk stratification and prognosis in patients with AMI.