摘要
目的探讨心功能正常且肌钙蛋白I(cTnI)阴性的不稳定型心绞痛患者在行择期经皮冠状动脉介入治疗(PCI)后血浆cTnI和N末端B型脑钠肽前体(NT-proBNP)水平变化及其与冠状动脉病变、PCI治疗、主要不良心脏事件(MACE)的关系。方法收集择期PCI 106例不稳定型心绞痛患者的临床资料,术前和术后24 h测定血浆cTnI、NT-proBNP水平,记录手术操作中的指标,随访MACE发生情况。结果 PCI术后24 h cTnI和NT-proBNP水平呈正相关(r=0.532,P<0.05)。手术相关参数比较显示分叉病变、多支病变、支架长度、球囊扩张总时间和总次数等因素在cTnI升高组及正常组之间比较,差异有统计学意义(P<0.05)。PCI术后cTnI和(或)NT-proBNP升高组患者MACE发生较多,且cTnI和NT-proBNP的ROC曲线下面积(AUC)分别为0.762和0.751,两组间比较,差异无统计学意义。cTnI+NT-proBNP预测符合率(87.1%)高于单一标志物cTnI(84.3%)、NT-proBNP(79.4%),具有更高的预测诊断价值。结论心肌缺血是促进NT-proBNP合成和释放的刺激因素之一;分叉病变、多支病变、支架长度、球囊扩张总时间和总次数等因素与PCI相关心肌损伤有关;cTnI+NT-proBNP的联合检测对PCI术后MACE发生具有更好的预测价值。
Objective To investigate the changes of plasma cTnⅠ and N-terminal pro-brain natriuretic peptide （NT-proBNP） levels and its relationship with coronary artery disease,PCI treatment and major adverse cardiac events （MACE） in unstable angina pectoris patients with normal cardiac function and negative cardiac troponin Ⅰ （cTnⅠ） after in elective percutaneous coronary intervention （PCI）.Methods We collected the clinical data of 106 patients who received elective PCI treatment measurement of plasma cTnⅠ,NT-proBNP levels in preoperative and 24 hours postoperative,were done and follow up MACE occurrence was recorded.Results The levels of cTnⅠ and NT-proBNP were positively correlated after PCI 24 hours （r=0.532,P ＜ 0.05）.Surgery-related parameters comparison shows that the difference between bifurcation lesions,multivessel disease,stent length differences,the total time and total number of balloon dilation was statistically significant between elevated cTnⅠ group and normal group （P ＜ 0.05）After PCI,patients in the cTnⅠ elevated group and/or the NT-proBNP elevated group showed higher occurence of MACE,and the area under the ROC curve （AUC）respectively were：AUC-cTnⅠ =0.762 and AUC-NT-proBNP =0.751.The AUC of cTnⅠ and NT-proBNP had no statistically significant difference.cTnⅠ＋NT-proBNP predicted coincidence rate （87.1％） higher than the single marker cTnⅠ （84.3％） and the NT-proBNP （79.4％）,has higher diagnostic value of prediction.Conclusions Myocardial ischemia is one of the important factor stimulating the NT-proBNP release.Factors including bifurcation lesions,multivessel disease,stent length differences,the total time and total number of balloon dilation are associated with PCI myocardial injury related.cTnⅠ＋NT-proBNP combined detection of MACE after PCI have better predictive value.
出处
《中国介入心脏病学杂志》
2014年第7期418-421,共4页
Chinese Journal of Interventional Cardiology
基金
山东省医药卫生科技发展计划项目(2009HZ097)
