B型钠尿肽与C-反应蛋白检测在急性心肌梗死诊断中的应用

Application of B-type natriuretic peptide and C-reaction protein detection in daignosis of acute myocardial infarction

目的探讨B型钠尿肽(BNP)与C-反应蛋白(CRP)检测在急性心肌梗死(AMI)诊断中的应用。方法选择2020年1—8月泗洪分金亭医院收治的144例AMI患者作为研究对象,纳入AMI组,根据Killp心功能分级将患者分为单纯AMI组(29例)、AMI合并Ⅰ~Ⅱ级心功能组(66例)、AMI合并Ⅲ~Ⅳ级心功能组(49例);根据冠状动脉(冠脉)病变支数Judkins法分为单支血管病变组(85例)、双支血管病变组(32例)、3支血管病变组(27例);另外选择同期130名健康体检者作为对照组。采用化学发光法检测各组BNP,采用乳胶比浊法检测CRP,比较各组上述指标检测结果。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评价BNP、CRP单独与联合检测对AMI的诊断效能。结果AMI组的BNP、CRP水平均明显高于对照组〔BNP(ng/L):158.63±5.63比22.15±5.61,CRP(g/L):11.36±1.18比3.98±1.16,均P<0.05〕。AMI合并Ⅰ~Ⅱ级、Ⅲ~Ⅳ级心功能组的BNP、CRP水平均明显高于单纯AMI组〔BNP(ng/L):148.96±5.38、169.96±5.99比125.63±5.26,CRP(g/L):13.25±1.85、16.15±1.99比9.58±1.02,均P<0.05〕;双支血管病变组、3支血管病变组的BNP、CRP水平均明显高于单支血管病变组〔BNP(ng/L):358.96±3.55、955.63±3.69比132.15±3.26,CRP(g/L):8.18±0.69、15.52±0.76比5.02±0.18,均P<0.05〕。联合检测对诊断AMI的阳性率明显高于血清BNP、CRP单独检测〔94.44%(136/144)比75.00%(108/144)、70.83%(102/144),均P<0.05〕,联合检测诊断AMI的AUC为0.972,95%可信区间(95%CI)为0.961~0.982,明显高于BNP(AUC为0.867,95%CI为0.838~0.895)与CRP(AUC为0.850,95%CI为0.819~0.880)单独检测。结论BNP与CRP联合检测在AMI中的应用价值较高,可用来预测心功能与血管病变程度。

Objective To explore the application of B-type natriuretic peptide(BNP)and C-reactive protein(CRP)levels in diagnosis of acute myocardial infarction(AMI).Methods The 144 patients with AMI admitted in Sihong Fenjinting Hospital from January to August 2020 were selected as AMI group.According to Killip classification,the patients were divided into AMI alone group(29 cases),AMI with gradeⅠ-Ⅱcardiac function group(66 cases)and AMI with gradeⅢ-Ⅳcardiac function group(49 cases).According to the number of coronary artery lesions and Judkins method,the patients were divided into single vessel lesion group(85 cases),double vessels lesion group(32 cases)and three vessels lesion group(27 cases).Other 130 physical examiners during the same period were selected as control group.The levels of BNP and CRP were detected by chemiluminescence method and latex turbidimetric method.The levels of above indexes were compared among groups.The receiver operator characteristic(ROC)curve was drawn,the area under ROC curve(AUC)was calculated to evaluate the diagnostic efficacy of BNP,CRP alone and jointly for AMI.Results The levels of BNP and CRP in AMI group were significantly higher than those in control group[BNP(ng/L):158.63±5.63 vs.22.15±5.61,CRP(g/L):11.36±1.18 vs.3.98±1.16,both P<0.05].The levels of BNP and CRP in AMI with gradeⅠ-ⅡandⅢ-Ⅳcardiac function groups were significantly higher than those in AMI alone group[BNP(ng/L):148.96±5.38,169.96±5.99 vs.125.63±5.26,CRP(g/L):13.25±1.85,16.15±1.99 vs.9.58±1.02,all P<0.05].The levels of BNP and CRP in double vessels lesion group and three vessels lesion group were significantly higher than those in single vessel lesion group[BNP(ng/L):358.96±3.55,955.63±3.69 vs.132.15±3.26,CRP(g/L):8.18±0.69,15.52±0.76 vs.5.02±0.18,all P<0.05].The positive rate of combined detection in the diagnosis of AMI was higher than those of single detection of serum BNP and CRP[94.44%(136/144)vs.75.00%(108/144),70.83%(102/144),both P<0.05].The AUC of the combined detection for diagnosis of AMI was 0.972,95%confidence interval(95%CI)was 0.961-0.982,which was significantly higher than those of BNP(AUC was 0.867,95%CI was 0.838-0.895)and CRP(AUC was 0.850,95%CI was 0.819-0.880).Conclusion The combined detection of BNP and CRP in AMI has significant value,high sensitivity and specificity,and can be used to predict cardiac function and vascular disease.