N-端脑钠素前体应用于急性冠状动脉综合征早期诊断及疗效监控的优势性研究

Advantage study on utilization of N-terminal pro-B-brain natriuretic peptide for early diagnosis and therapeutic effect monitoring of acute coronary syndrome

目的研究N-端脑钠素前体(NT-proBNP)在急性冠状动脉综合征(ACS)早期诊断及疗效监测中的临床优势。方法选取2014年2~12月因胸部疼痛或不适感明显在该院心内科就诊且行冠状动脉造影的患者97例,其中34例非ACS患者纳入对照组,63例ACS患者分别纳入ST段抬高型心肌梗死(STEM)组、非ST段抬高型心肌梗死(NSTEM)组、不稳定型心绞痛(UA)组。观察各组患者血糖、血脂、血压及NT-proBNP等指标。结果各组患者空腹血糖均在正常参考值范围内,而血脂、血压、NT-proBNP均高于正常参考值范围,且NT-proBNP水平远高于预后良好的标准(NT-proBNP<200pg/mL)。各组血浆NTproBNP水平比较差异有统计学意义(P<0.05),其余各指标比较差异均无统计学意义(P>0.05)。ACS患者的各治疗阶段血脂、NT-proBNP水平及血压均明显降低。结论心肌标志物NT-proBNP在ACS早期诊断中具有较高的准确度,可用于临床疗效监测,指导合理地选择治疗策略。

Objective To explore clinical advantages of N-terminal pro-B-brain natriuretic peptide(NT-proBNP)in early diagnosis and therapeutic effect monitoring of acute coronary syndrome(ACS).Methods A total of 97 cases of patients with chest pain and obvious discomfort who treated with coronary angiography in this hospital from February to December 2014 were selected.Among these patients,34 cases with non-ACS were enrolled in the control group,while other 63 cases with ACS were divided into the ST-segment elevation myocardial infarction(STEM)group,non-ST-segment elevation myocardial infarction(NSTEM)group and unstable angina pectoris(UA)group.The glycemia,lipemia,blood pressure and other indicators were observed.Results The levels of fasting blood-glucose were within the normal reference interval in all groups,while levels of lipemia,plasma NT-proBNP and blood pressure were higher than the upper limits of normal reference intervals,and plasma levels of NT-proBNP were higher than standard of good prognosis(NT-proBNP<200pg/mL).There was statistically significant difference in plasma levels of NT-proBNP among these groups(P<0.05),while no statistically significant differences were found in other indicators among these groups(P>0.05).The levels of lipemia and plasma NT-proBNP and blood pressure were obviously decreased in patients with ACS at each treatment stage.Conclusion NT-proBNP as a kind of myocardial marker has high accuracy in early diagnosis of ACS,which could be applied in therapeutic effect monitoring and provide guidance for reasonable selection of treatment strategy.