血浆标志物与ST段抬高型急性心肌梗死患者住院期间主要不良心脏事件相关性研究

Association of plasma biomarkers with major adverse cardiac events in patients with ST-segment elevation acute myocardial infarction

目的检测ST段抬高型急性心肌梗死(STEAMI)患者血浆心肌肌钙蛋白I(cTnI)、精氨酸-加压素(AVP)、和肽素(COP)、心钠肽(ANP)、脑钠肽(BNP)、氨基末端脑钠肽原(NT-proBNP)和肾上腺素髓质素(ADM)浓度,探讨其对心肌梗死患者住院期间主要不良心脏事件(MACE)发生的预测价值。方法收集STEAMI患者和健康体检者各118例,ELISA法检测血浆cTnI、AVP、COP、ANP、BNP、NT-proBNP和ADM浓度,评价和比较其对急性心肌梗死患者住院期间主要MACE发生的预测价值。结果STEAM患者血浆cTnI、AVP、COP、ANP、BNP、NT-proBNP和ADM浓度均显著高于健康体检者(均P<0.01)。35例(29.7%)出现MACE。MACE患者血浆中上述激素的浓度均显著高于无MACE患者(均P<0.01)。ROC曲线分析显示,血浆中这些激素水平均可显著预测住院期间MACE发生(均P<0.01),而COP及NT-proBNP的预测价值优于cTnI(均P<0.05)。联合检测血浆COP及NT-proBNP可进一步提高血浆COP及NT-proBNP单独检测的预测价值(均P<0.05)。结论血浆COP及NT-proBNP浓度对STEAMI患者住院期间主要不良心脏事件的预测价值较高,而联合检测血浆COP及NT-proBNP浓度更具有临床价值。

Objective To investigate the association of plasma biomarkers with major adverse cardiac events（MACE） in patients with ST-segment elevation acute myocardial infarction（STEAMI）. Methods One hundred and eighteen consecutive patients with STEAMI and 118 healthy subjects were enrolled in this study. Plasma cardiac troponin I （cTn I ）, arginine vaso- pressin（AVP）, copeptin, atrial natriuretic peptide（ANP）, brain natriuretic peptide （BNP）, N-terminal fragment of pro-brain natri- uretic peptide （NT-proBNP） and adrenomedullin （ADM） levels were measured by ELISA, and their association with in-hospital MACEs of patients was analyzed, Results Plasma cTn I, AVP, copeptin, ANP,BNP, NT-proBNP and ADM levels in STEAMI pa- tients were significantly higher than those in healthy controls （all P〈0.01）. MACEs developed in 35 patients（29,7%） during hospi- talization. The plasma levels of these parameters in patients with MACEs were significantly elevated compared with patients with- out MACE （aft P〈0.01）. ROC curve analysis showed that the predictive value of plasma copeptin and NT-proBNP for MACEs markedly exceeded that of plasma cTn I levels （both P〈0.05）, and the combined determination of plasma copeptin and NT-proBNP further improved the predictive value of （both P〈0.05）. Conclusion Plasma copeptin and NT-proBNP levels show high predictive values for occurrences of in-hospital MACEs in STEAMI patients and the combined determination of two biomarkers may further improve their predictive value.