B-型钠尿肽及D-二聚体在老年急性心肌梗死预后判断中的价值

Effect of B-type natriuretic peptide and D-dimer on the prognosis judgement of elderly patients with acute myocardial infarction

目的：评价B-型钠尿肽（BNP）及D-二聚体（D-dimer）在老年急性心肌梗死（AMI）预后判断中的临床应用价值。方法选择发病6 h内的老年急性心肌梗死患者123例为观察组，无冠状动脉疾病的体检者46例为对照组。采用化学发光法及免疫比浊法检测入选者血浆BNP及D-dimer水平，并对观察组患者随访1年，平均3个月随访1次。结果 AMI后血浆BNP及D-dimer水平与对照组比较明显升高（P﹤0.01）。AMI组、心力衰竭组和死亡组血浆中BNP、D-dimer水平显著高于梗死后心绞痛组和治疗后恢复期组（ P﹤0.01）。住院期间及1年随访期间发生心血管事件患者的血浆BNP水平明显高于未发生者（ P﹤0.01），心血管事件在BNP较高的患者中也较多（ P﹤0.05），血浆BNP水平与病死率呈正相关（r=0.54，P﹤0.01）。AMI早期治疗后血浆BNP与D-dimer水平显著下降（P﹤0.01）。结论血浆BNP及D-dimer水平在老年AMI患者中明显升高，且升高水平与病情的严重程度密切相关，故血浆BNP、D-dimer水平对老年AMI患者病情的转归和疗效评估有实际的临床价值。

Objective To evaluate the clinical application value of B-type natriuretic peptide and D-dimer on the prognosis judgement of elderly patients with acute myocardial infarction（ AMI ）. Methods One hundred and twenty-three AMI patients within six hours of onset were chose as observation group,and 46 physical examinees without coronary artery disease were chose as control group. The plasma BNP and D-dimer levels were detected by chemiluminescence and immunoturbidimetry,and the patients in observation group were followed up for 1 year,every 3 months one time. Results After AMI, the plasma BNP and D-dimer levels were significantly higher than those of the control group（ P﹤0. 01 ）. The BNP and D-dimer levels in plasma of AMI group,heart failure group and death group were significantly higher than those of the post-infarction angina group and recovery group（ P﹤0. 01 ）. The plasma BNP levels in patients with cardiovascular events during hospitalization and 1-year follow-up were significantly higher than those in patients without cardiovascular events（ P ﹤0. 01 ）. Cardiovascular events in patients with higher BNP levels were more（ P﹤0 . 05 ）. The plasma BNP levels were positively correlated with mortality（ r=0. 54 ,P﹤0. 01 ）. The plasma BNP and D-dimer levels of patients with AMI signifi-cantly decreased after early treatment（ P﹤0. 01 ）. Conclusions The plasma BNP and D-dimer levels of elderly patients with AMI increase obviously,and the elevated levels are closely correlated with the severity of the disease,so the plasma BNP and D-dimer levels have practical clinical value on the disease outcome and efficacy assessments of the elderly patients with AMI.