血清B型钠尿肽与肌钙蛋白I水平变化在心脏骤停心肺复苏成功患者近期预后评估中的意义

Significance of changes in serum levels of B-type natriuretic peptide and trononin I in evaluation of short-term prognosis in patients with sudden cardiac arrest after cardiopulmonary resuscitation

目的 探讨在心脏骤停心肺复苏（CPR）成功患者CPR后不同时间血清B型钠尿肽（BNP）与肌钙蛋白I（TNI）的水平变化及其与近期预后的关系。方法 分别检测60例心脏骤停CPR成功患者CPR后即刻、3 h、12-24 h的血清BNP与TNI水平,根据CPR后不同时间点血清BNP的变化特点分为3组,A组为各时间点血清BNP水平一直小于200 pg/ml,B组为CPR后即刻BNP水平小于200 pg/ml,3 h和12-24 h BNP水平持续升高,且大于200 pg/ml;C组为CPR后即刻BNP水平小于200 pg/ml,3 h BNP水平大于200 pg/ml,但12-24 h BNP水平较3 h时降低。随访三组患者CPR后6个月的死亡情况。结果 BNP和TNI具有交互作用（P〈0.05）,即TNI表达水平随着血清BNP水平变化而变化。BNP高表达组（〉400 pg/ml）、TNI高表达组（〉1.5 ng/ml）患者病死率分别高于BNP、TNI低表达组（P〈0.05）。B组病死率明显高于A组和C组（P〈0.05）;生存分析结果显示,B组患者6个月生存率低于A组及C组（P〈0.05）,A组和C组比较,差异无统计学意义（P〉0.05）。结论 血清BNP与TNI水平变化能较好地评估心脏骤停CPR成功患者的近期临床预后。

Objective To investigate the changes in serum levels of B-type natriuretic peptide（ BNP） and trononin I（ TNI） in patients with sudden cardiac arrest at different time points after successful cardiopulmonary resuscitation（ CPR）,and to explore their relationship with short-term prognosis. Methods Sixty patients with sudden cardiac arrest who had undergone successful CPR received the detection of serum BNP and TNI at the instant of CPR,3 and 12 to 24 hours after CPR,respectively. The patients were divided into three groups according to the variation features of BNP at different time points after CPR. The patients with the BNP level less than 200 pg / ml at various time points were enrolled in Group A. The patients with the BNP level less than 200 pg / ml at the instant of CPR,and with sustained increase of BNP level more than 200 pg / ml 3 and 12 to 24 hours after CPR were enrolled in Group B. The patients with the BNP level less than 200 pg / ml at the instant of CPR,and with the BNP level more than 200 pg / ml 3 hours after CPR which was more than the level 12 to 24 hours after CPR were enrolled in Group C. During the follow-up of 6 months,the mortality of the patients in three groups was observed. Results The interaction was found between BNP and TNI（ P〈0. 05）,which revealed that the serum level of TNI changed with the serum level of BNP. The mortality in the high-expression BNP group（〉 400 pg / ml） was higher than that in the low-expression BNP group,while the mortality in the high-expression TNI group（〉 1. 5 ng / ml） was higher than that in the low-expression TNI group（ P〈0. 05）. The mortality of Group B was significantly higher than that of Group A or Group C（ P〈0. 05）. The survival analysis revealed that the 6-month survival rate of Group B was lower than that of Group A or Group C（ P〈0. 05）,but there was no significant difference in the 6-month survival rate between Group A and Group C（ P〉0. 05）. Conclusion The serum levels of BNP and TNI can better evaluate the short-term prognosis of patients with sudden cardiac arrest who has undergone successful CPR.