急性心肌梗死患者PCI手术前后CRP、NT-proBNP、CK-MB、cTnT水平测定及临床意义

Expression level of CRP,NT-proBNP,CK-MB,cTnT and clinical significance analysis for patients with acute myocardial infarction before and after PCI

目的：分析急性心肌梗死患者行经皮冠状动脉介入治疗（PCI）手术前后C反应蛋白（CRP）、N-末端脑钠肽前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）、肌钙蛋白（cTnT）水平变化及临床意义,为临床治疗提供科学依据。方法：选取2012年1月～2014年12月医院收诊的122例急性心肌梗死患者（观察组）的临床资料进行回顾性分析,观察组行PCI,术后分为cTnT降低组、cTnT不变组和NTproBNP降低组、NT-proBNP不变组,并选择122例体检健康者作为对照组。于手术前后24h内常规肘静脉取血检查CRP、NT-proBNP、CK-MB、cTnT水平,比较各指标的差异。结果：（1）观察组治疗前CRP、NT-proBNP、CK-MB、cTnT显著高于对照组（P〈0.05）,手术后NT-proBNP、cTnT、CRP、CKMB均有所下降,与术前相比差异有统计学意义（P〈0.05）。（2）观察组介入治疗后cTnT与NT-proBNP水平呈正比关系。（3）cTnT降低组、cTnT不变组和NT-proBNP降低组、NT-proBNP不变组的不稳定型心绞痛、糖尿病、分叉病变、多支病变以及球囊扩张总时间和总次数方面差异有统计学意义（P〈0.05）。但支架长度仅在cTnT降低组与cTnT不变组间差异有统计学意义（P〈0.05）,在NT-proBNP降低组与NT-proBNP不变组间差异无统计学意义（P〉0.05）。Logistic分析发现,不稳定型心绞痛、糖尿病、分叉病变、多支病变以及球囊扩张总时间和总次数是影响急性心肌梗死患者术后cTnT与NTproBNP水平变化的相关因素,而支架长度是影响cTnT水平变化的相关因素。（4）cTnT降低组与NT-proBNP降低组的心脏不良事件发生率与cTnT不变组和NT-proBNP不变组相比,差异具有统计学意义（P〈0.05）。结论：急性心肌梗死患者CRP、NT-proBNP、CK-MB、cTnT水平显著高于健康人,且cTnT与NT-proBNP水平在预测急性心肌梗死患者在PCI术后心脏不良事件发生率方面具有预判作用。

Objective：To analyze level changes of CRP,NT-proBNP,CK-MB,cTnT and clinical significance for patients with acute myocardial infarction before and after PCI and then provide scientific basis for clinical observation of the therapeutic effect of percutaneous coronary intervention（PCI）for patients with acute myocardial infarction.Method：A total of 122 cases with acute myocardial infarction who were admitted in our hospital from January 2012 to December 2014 were selected and retrospective analysis was performed on their clinical data.Meanwhile 122 cases with healthy physical examination in our hospital were selected as control group.CRP、NT-proBNP,CK-MB,cTnT difference in study group before PCI were compared with that in control group.Patients in study group were performed with PCI,and conventional elbow vein blood was collected for CRP、NT-proBNP,CK-MB,cTnT level determination within 24 hbefore and after PCI,and then CRP,NT-proBNP,CK-MB,cTnT level changes and clinical significance before and after PCI were analyzed.Results：（1）CRP,NT-proBNP,CK-MB,cTnT levels of patients in study group were significantly higher than that in control group and comparative difference had statistical significance（P〈0.05）.（2）NT-proBNP,cTnT,CRP,CK-MB levels of patients in study group were reduced after PCI,and compared with levels before PCI,difference had statistical significance（P〈0.05）.（3）cTnT and NT-proBNP levels of patients in study group presented proportional relations after PCI,we could infer NT-proBNP level had a certain relations with myocardial ischemia.（4）122cases with acute myocardial infarction were divided into cTnT Drop Group＆cTnT Unchanged Group and NT-proBNP Drop Group＆NT-proBNP Unchanged Group after PCI according to cTnT and NT-proBNP level changes,and their difference on the total time and total times of unstable angina pectoris,diabetes,bifurcation lesion,multi-vessel lesions and balloon dilatation had statistical significance（P〈0.05）.Stent length difference had statistical significanceonly in cTnT Drop Group＆cTnT Unchanged Group（P〈0.05）,while difference had no statistical significance in NT-proBNP Drop Group＆NT-proBNP Unchanged Group.Logistic analysis found that total time and total times of unstable angina pectoris,diabetes,bifurcation lesion,multi-vessel lesions and balloon dilatation were the relevant factors affecting postoperative cTnT and NT-proBNP level changes for patients with acute myocardial infarction,and stent length was the relevant factor affecting cTnT level changes.（5）Heart adverse event occurrence rate in cTnT Drop Group and NT-proBNP Drop Group was compared with that in cTnT Unchanged Group and NT-proBNP Unchanged Group,difference had statistical significance（P〈0.05）.Conclusions：CRP,NT-proBNP,CK-MB,cTnT levels of patients with acute myocardial infarction were significantly higher than that of healthy people,and cTnT and NT-proBNP levels had prognosis effect in the prediction of heart adverse event occurrence rate of patients with acute myocardial infarction after PCI.