急性心肌梗死患者血浆B型利钠肽水平与其相关因素的临床研究

The clinical research of plasma B-type natriuretic peptide level and the related factors in patients with acute myocardial infarction

目的：通过分析急性心肌梗死患者血浆B型利钠肽（B-type Natriuretic Peptide,BNP）水平与相关临床因素的关系,探讨BNP在急性心肌梗死临床诊治中的作用及意义。方法：回顾性分析冠病患者159例临床资料,急性心肌梗死98例,包括ST段抬高型心肌梗死（STEMI）54例,非ST段抬高型心肌梗死（NSTEMI）44例,同期不稳定型心绞痛35例,稳定性心绞痛26例。所有入选病例均为入院24 h内测定血浆BNP浓度、心肌标志物测定,进行超声心动图检查,记录患者心功能Killip分级等。结果：（1）急性心肌梗死组患者血浆BNP水平显著高于不稳定型心绞痛组及稳定型心绞痛组（P〈0.01）;STEMI患者血浆BNP水平明显高于NSTEMI组,差异有统计学意义;不稳定型心绞痛组与稳定型心绞痛组血浆BNP水平,差异无统计学意义。（2）急性心肌梗死组患者血浆BNP水平随着心功能Killip分级（Ⅰ~Ⅳ）升高和左室射血分数（LVEF）降低而梯次升高,差异均有统计学意义（P〈0.05）,血浆BNP水平与Killip分级呈正相关（r=0.851,P〈0.01）,与LVEF呈负相关（r=-0.714,P〈0.01）,与LVEDs、LVEDd均呈正相关（分别为r1=0.427,r2=0.482,P〈0.01）,与Gensini积分呈正相关（r=0.452,P〈0.01）,与冠脉病变支数呈正相关（r=0.332,P=0.002）。（3）STEMI和NSTEMI亚组患者血浆BNP与LVEF均呈负相关,与LVEDs、LVEDd、Gensini积分均呈正相关。结论 ：血浆BNP水平可作为反映急性心肌梗死患者病情轻重的指标之一,与心梗后心功能状态、左室重构情况及冠脉病变程度相关,有助于心梗后心功能及预后判断,可参与急性心肌梗死患者的危险分层并发现心梗后高危人群。

Objective：Through the analysis of the relationship between B-type natriuretic peptide（BNP） level and the related clinical factors in patients with Acute Myocardial Infarction（AMI）,to explore the role of BNP in AMI＇s clinical diagnosis and treatment and significance. Methods： Retrospective analysis of some cases of patients with Coronary heart disease of nantong university affiliated hospital from 2013.11 to 2014.10. Including 98 cases of patients with Acute myocardial infarction（AMI）（STEMI 54 cases,NSTEMI 44 cases）,35 cases of patients with Unstable angina, and 26 cases of patients with Stable angina pectoris. All the admitted cases to complete the following items within 24 hours： determination of plasma BNP concentration, the myocardial necrosis markers, determination of echocardiography, and record cardiac function in patients with Killip classification,etc. Results：（1）Plasma BNP level in patients with AMI was significantly higher than that of unstable angina and stable angina pectoris group（P〈0.01）;Plasma BNP level in patients with STEMI was significantly higher than that in NSTEMI group, the difference was statistically significant（P〈0.05）;Plasma BNP level in patients with unstable angina and stable angina pectoris group has no statistically significant difference.（2）After AMI, the plasma BNP level increased significantly in proportion with increasing Killip grades（Ⅰ~Ⅳ）,and decreasing LVEF（all P〈0.05）. The plasma BNP level was positively related with Killip classification（r=0.851, P〈0.01）, negatively correlated with LVEF（r =-0.714, P〈0.01）, positively related with LVEDs and LVEDd（r1=0.427, r2=0.482, P〈0.01）, positively related with Gensini score（r=0.452, P〈0.01）, and positively related with coronary artery lesion counts（r=0.332, P〈0.01）.（3）Plasma BNP level was negatively correlated with LVEF,positively related with LVEDs,LVEDd and Gensini score in patients with STEMI and NSTEMI. Conclusions：The plasma BNP level can be used as the illness weight indicator of patients with acute myocardial infarction, and it can also reflect cardiac function and left ventricular remodeling after AMI, it may be helpful for the risk stratification and prognosis determination of AMI.