cTnI、NT—proBNP、D-二聚体的检测在急性冠状动脉综合征的临床应用

Clinical application of cTnI, NT- proBNP and D- dimmer in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征（ACS）患者血清心肌肌钙蛋白I（（cTnI）和N末端脑钠肽前体（NT—proBNP）及血浆D-二聚体在ACS早期诊断和危险分层及其治疗前后变化的临床意义。方法测定ACS患者103例治疗前后及25例正常对照者血cTnl、NT—proBNP及D-二聚体，并比较各组血清cTnl与NT—proBNP水平的相关性。对71例急性心肌梗死（AMI）患者进行心功能Killip分级，分析AMI患者NT—proBNP水平与心功能Killip分级的相关性。结果STEMI组和NSTEMI组血cTnI、NT—proBNP及D-二聚体水平明显高于UA组，UA组高于正常对照组（P〈0．01），各组血清cTnI与NT—proBNP水平呈正相关（r=0．417，P〈0．01）；经治疗后STEMI组和NSTEMI组及UA组血cTnI、NT—proBNP、D-二聚体水平均较治疗前明显降低（P〈0．05）；AMI患者NT—proBNP水平与心功能Killip分级呈正相关（r=0．401，P〈0．05）。结论联合检测cTnI、NT—proBNP及D-二聚体对ACS的早期诊断和危险分层及治疗具有重要的临床意义。

Objective To investigate the levels of serum cTnI, NT - proBNP and D - dimmer in patients with acute coronary syndrome （ACS） and to discuss their application for early diagnosis, grading and treatment. Methods A total of 103 patients who were admitted into Departments of Cardiology and Emergency of our hospital due to ACS from Decem- ber 2013 to March 2014 were included into the current study. Among these patients were 45 cases of acute ST - segment elevation myocardial infarction （STEMI） , 26 cases of acute non- ST- segment elevation myocardial infarction （NSTE- MI）, and 32 cases of unstable angina pectoris （UA）. Meanwhile, 25 healthy subjects were enrolled as the control. Then, their levels of cTnI, NT - proBNP and D - dimer were measured before and after treatment to compare a potential relationship between serum cTnI and NT - proBNP in each group. Also, according to Killip classification, the cardiac functions of 71 patients with acute myocardial infarction （AMI） were assessed to analyze a possible relationship between their level of NT - proBNP and cardiac function grades. Results Compared with the control group, the UA group pro- duced higher amounts of serum cTnT, NT - proBNP and D - dimmer. However, the levels of serum cTnT, NT - proBNP and D - dimmer in the STEMI and NSTEMI groups were significantly higher than that in the UA group （ P 〈 0.01 ）. A positive relationship was present between serum cTnI and NT -proBNP in each group （r = 0. 417, P 〈 0.01 ）. After treatment, the levels of serum cTnI, NT - proBNP and D - dimer in these three groups were remarkably reduced in com- parison with the pre - treatment amounts （ P 〈 0.05 ）. The quantity of NT - proBNP was positively correlated with cardiac function grades （ r = 0. 401, P 〈 0.05 ）. Conclusions Detection of cTnI, NT - proBNP and D - dimmer is of impor- tance to diagnose, grade and treat ACS.