急性心肌梗死患者心脏标志物四项与PCT、BNP的相关性

Correlation between four cardiac markers and procalcitonin,brain natriuretic peptide levels in patients with acute myocardial infarction

目的探讨急性心肌梗死患者心脏标志物四项与降钙素原(PCT)、脑钠肽(BNP)的相关性。方法选择2018年1月至2020年4月东莞市石排医院收治的117例急性心肌梗死患者作为观察组,并选择同期于我院体检的100例健康者作为对照组。比较两组受检者纳入研究后次日的肌钙蛋白T(cTnT)、肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、PCT和BNP水平,并比较观察组不同心功能分级、不同预后患者的上述各项观察指标水平,使用Cox回归分析模型分析影响急性心肌梗死患者的危险因素,采用Pearson相关系数分析cTnT、cTnI、CK-MB、Myo和PCT、BNP的相关性。结果观察组患者的血清cTnT、cTnI、CK-MB、Myo、PCT、BNP水平分别为(45.51±6.92)μg/L、(4.03±0.61)μg/L、(48.56±4.72)U/L、(281.82±36.96)μg/L、(0.48±0.07)μg/L、(886.10±162.34)pg/mL,明显高于对照组的(0.09±0.02)μg/L、(0.16±0.03)μg/L、(12.94±2.87)U/L、(45.71±3.82)μg/L、(0.12±0.03)μg/L、(49.52±6.18)pg/mL,差异均有统计学意义(P<0.05);观察组心功能分级Ⅳ级患者的血清cTnT、cTnI、CK-MB、Myo、PCT、BNP水平分别为(58.65±4.71)μg/L、(5.13±0.79)μg/L、(62.95±6.71)U/L、(402.17±69.10)μg/L、(0.85±0.07)μg/L、(1383.21±271.93)pg/mL,明显高于心功能分级Ⅲ级患者的(46.20±6.38)μg/L、(3.97±0.44)μg/L、(50.05±4.62)U/L、(290.64±41.39)μg/L、(0.47±0.10)μg/L、(700.81±139.40)pg/mL和心功能分级Ⅱ级患者的(33.94±5.17)μg/L、(2.66±0.53)μg/L、(34.71±3.88)U/L、(187.32±36.55)μg/L、(0.21±0.04)μg/L、(472.31±95.63)pg/mL,且心功能分级Ⅲ级的患者上述指标均明显高于Ⅱ级患者,差异均有统计学意义(P<0.05);治疗1个月后,观察组中死亡组患者血清cTnT、cTnI、CK-MB、Myo、PCT、BNP水平分别为(59.81±5.30)μg/L、(5.38±0.76)μg/L、(65.03±7.04)U/L、(421.03±71.57)μg/L、(0.90±0.11)μg/L、(1585.32±371.04)pg/mL,明显高于存活组的(40.18±4.25)μg/L、(3.63±0.51)μg/L、(42.60±4.86)U/L、(251.69±53.22)μg/L、(0.48±0.07)μg/L、(782.95±215.36)pg/mL,差异均有统计学意义(P<0.05);经Cox回归分析模型显示,cTnT、cTnI、CK-MB、Myo、PCT、BNP均是影响急性心肌梗死患者死亡的独立危险因素(P<0.05);经Pearson相关性分析结果显示,cTnT、cTnI、CK-MB、Myo和PCT、BNP均呈正相关(P<0.05)。结论血清cTnT、cTnI、CK-MB、Myo、PCT、BNP水平在急性心肌梗死患者中均具有高表达,且血清cTnT、cTnI、CK-MB、Myo和PCT、BNP均呈明显正相关,有助于判断病情程度,临床应用价值高。

Objective To study the correlation between four cardiac markers and procalcitonin(PCT),brain natriuretic peptide(BNP)levels in patients with acute myocardial infarction.Methods A total of 117 patients with acute myocardial infarction admitted to Dongguan Shipai Hospital from January 2018 to April 2020 were selected as the observation group,and 100 healthy people who received physical examination in the hospital at the same time were selected as the control group.The expression levels of troponin T(cTnT),troponinⅠ(cTnⅠ),creatine kinase isoenzyme(CK-MB),myoglobin(Myo),PCT,and BNP were compared between the two groups on the next day after inclusion,and the above indexes of patients with different cardiac function grades and different prognosis were compared.The risk factors of patients with acute myocardial infarction were analyzed by Cox regression analysis model.Pearson correlation coefficient was used to analyze the correlation between cTnT,cTnI,CK-MB,Myo and PCT,BNP.Results The serum cTnT,cTnI,CK-MB,Myo,PCT,and BNP levels in the observation group were(45.51±6.92)μg/L,(4.03±0.61)μg/L,(48.56±4.72)U/L,(281.82±36.96)μg/L,(0.48±0.07)μg/L,(886.10±162.34)pg/mL,which were significantly higher than(0.09±0.02)μg/L,(0.16±0.03)μg/L,(12.94±2.87)U/L,(45.71±3.82)μg/L,(0.12±0.03)μg/L,(49.52±6.18)pg/mL in the control group(P<0.05).In the observation group,the serum cTnT,cTnI,CK-MB,Myo,PCT,and BNP levels of patients with cardiac function gradeⅣwere(58.65±4.71)μg/L,(5.13±0.79)μg/L,(62.95±6.71)U/L,(402.17±69.10)μg/L,(0.85±0.07)μg/L,(1383.21±271.93)pg/mL,which were significantly higher than(46.20±6.38)μg/L,(3.97±0.44)μg/L,(50.05±4.62)U/L,(290.64±41.39)μg/L,(0.47±0.10)μg/L,(700.81±139.40)pg/mL of the patietns with cardiac function gradeⅢand(33.94±5.17)μg/L,(2.66±0.53)μg/L,(34.71±3.88)U/L,(187.32±36.55)μg/L,(0.21±0.04)μg/L,(472.31±95.63)pg/mL of the patients with cardiac function gradeⅡ,and the levels of the patients with cardiac function gradeⅢwere significantly higher than those of the patients with cardiac function gradeⅡ,all with statistically significant differences(P<0.05).After one month of treatment,serum cTnT,cTnI,CK-MB,Myo,PCT,and BNP levels in the death subgroup of the observation group were(59.81±5.30)μg/L,(5.38±0.76)μg/L,(65.03±7.04)U/L,(421.03±71.57)μg/L,(0.90±0.11)μg/L,(1585.32±371.04)pg/mL,which were significantly higher than(40.18±4.25)μg/L,(3.63±0.51)μg/L,(42.60±4.86)U/L,(251.69±53.22)μg/L,(0.48±0.07)μg/L,(782.95±215.36)pg/mL in the survival subgroup(P<0.05).Cox regression model showed that serum cTnT,cTnI,CK-MB,Myo,PCT,and BNP were independent risk factors affecting the death of patients with acute myocardial infarction(P<0.05).Pearson correlation analysis showed that cTnT,cTnI,CK-MB,Myo were positively correlated with PCT and BNP(P<0.05).Conclusion Serum cTnT,cTnⅠ,CK-MB,Myo,PCT,and BNP levels were highly expressed in patients with acute myocardial infarction,and cTnT,cTnⅠ,CK-MB,Myo are positively correlated with PCT,BNP,which is helpful to judge the severity of the disease,and had high clinical application value.