摘要
目的探讨氨基末端B型钠尿肽原(NT-proBNP)浓度变化对冠心病(CHD)患者诊断和预后的意义。方法采用双向侧流免疫法检测132例CHD患者[按病情严重程度分为无症状组、稳定性心绞痛(SAP)组、不稳定性心绞痛(UAP)组、急性心肌梗死(AM I)组]和30名健康对照者及34例急性冠状动脉综合征(ACS)患者住院后第7天、第15天、第30天血清NT-proBNP和肌钙蛋白I(cTnI)水平。CHD患者同步作心电图检查。所有患者平均随访180 d,观察随访期间发生的主要不良心脏事件(MACE)。结果 CHD不同病变程度各组血清NT-proBNP水平明显高于对照组(P<0.01),且随冠状动脉病变程度加重逐渐升高,并与患者心功能分级[美国纽约心脏协会(NYHA)Ⅰ～Ⅳ]呈正相关(r=0.81,P<0.01)。NT-proBNP>1 596.63 ng/L的CHD患者NYHAⅢ～Ⅳ级、心电图ST-T改变、随访期内出现MACE的例数明显高于NT-proBNP≤1 596.63 ng/L者(P<0.01)。ACS患者好转出院组治疗后第7天血清NT-proBNP水平显著降低(P<0.01),且随着治疗时间延长继续下降。死亡组治疗过程中血清NT-proBNP水平逐渐升高,治疗后第15天血清NT-proBNP水平明显高于治疗前(P<0.01)。心力衰竭(HF)恶化组治疗前、后血清NT-proBNP水平差异无统计学意义(P>0.05)。cTnI阴性死亡组与cTnI阳性死亡组NT-proBNP水平差异无统计学意义(P>0.05)。结论血清NT-proBNP水平与CHD严重程度密切相关,对CHD患者早期诊断、预后及死亡风险评估有重要的临床价值,可以作为CHD患者危险分层的监测指标。
Objective To study the diagnosis and prognosis significance of serum N-terminal pro-B-type natriuretic peptide（NT-proBNP）levels in patients with coronary heart disease（CHD）.Methods 132 patients with CHD were classified into the symptomless group,stable angina pectoris（SAP）group,unstable angina pectoris（UAP）group and acute myocardial infarction（AMI）group according to the severe degree of CHD.30 healthy controls were enrolled,and 34 patients with acute coronary syndrome（ACS）were hospitalized and detected on the 7th d,15th d and 30th d.Their serum NT-proBNP and cardiac troponin I（cTnI） levels were measured by bi-directional lateral flow immunoassay.The patients with CHD were synchronously examined by electrocardiogram.The main adverse cardiovascular events（MACE） were followed up for 180 d.Results The serum NT-proBNP levels in patients with various CHD were significantly higher than those in the healthy controls（P0.01）.The degree of CHD was more severe with the increasing level of serum NT-proBNP.The serum NT-proBNP level was positively correlated with New York Heart Association（NYHA） Ⅰ-Ⅳ（r=0.81,P0.01）.The cases of MACE with NYHA Ⅲ-Ⅳ and ST-T changes during the follow-up period in CHD patients with NT-proBNP1 596.63 ng/L were significantly higher than those with NT-proBNP≤1 596.63 ng/L（P0.01）.The serum NT-proBNP levels in improved ACS patients on the 7th d after treatment decreased significantly（P0.01）,and the level decreased gradually in follow-up period.The serum NT-proBNP levels of the death group on the 15th d after treatment were significantly higher than those before treatment,and the level gradually increased in the course of treatment（P0.01）.The serum NT-proBNP levels of the worsening heart failure（HF） group before and after the treatment had no significant difference（P0.05）.The serum NT-proBNP levels of death group with negative cTnI and death group with positive cTnI were not significantly different（P0.05）.Conclusions The levels of serum NT-proBNP are closely correlated with the severity of CHD,which have an important clinical value in the early diagnosis,prognosis and death risk evaluation.NT-proBNP can be used as a monitoring indicator of CHD risk stratification.
出处
《检验医学》
CAS
北大核心
2011年第5期312-316,共5页
Laboratory Medicine
基金
湖南省自然科学基金计划项目(10JJ5021)
关键词
氨基末端B型钠尿肽原
冠心病
急性冠状动脉综合征
N-terminal pro-B-type natriuretic peptide
Coronary heart disease
Acute coronary syndrome
