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[摘要] 目的 探讨脑利钠肽(BNP)水平与急性冠脉综合征(ACS)患者主要心脏不良事件(MACE)(心源性死亡,再次心肌梗死,再发心绞痛,继发心衰和再入院的复合终点)发生率的关系。方法 本院心内科住院资料完整的急性冠脉综合征患者98例,入院后24h内测血浆脑利钠肽水平,所有患者根据血浆脑利钠肽水平分为三组:A组BNP水平≤100ng/L,B组100ng/LB组>A组,三组之间有显著性差异。结论 急性冠脉综合征患者入院时BNP水平越高,其MACE发生率越高,BNP测定对ACS患者MACE有较强的预测价值。
[关键词] 急性冠脉综合征;脑利钠肽;冠状动脉造影;主要心脏不良事件;冠状动脉旁路移植术
[中图分类号] R543.304 [中图分类号] A[文章编号] 1673-9701(2009)24-16-03
Relationship between Serum Brain Natriuretic Peptide and Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome
JI JunHE Shenghu△CHEN ShuXIE YongLIU XiaodongXU Rixin
Department of Cardiology,Subei People"s Hospital of Jiangsu province,Yangzhou,Jiangsu 225001,China
[Abstract] Objective To explore the correlation of serum brain natriuretic peptide(BNP) and the major adverse cardiac events(MACEs) in the patients with acute coronary syndrome(ACS). Methods Ninty-eight patients whose data were available were enrolled in this study, serum BNP level was measured in the patients with ACS during 24 hours after admission,and the patients were divided into 3 groups based on the BNP level,Group A:BNP level≤100ng/mL; Group B:100ng/ml 接受冠状动脉造影者符合:(1)入院诊断符合2000年ACC/ AHA制定的ACS治疗指南中的诊断标准[4];(2)病情允许行冠状动脉造影;(3)血管狭窄程度以血管直径狭窄百分数统计:50%～75%为轻度狭窄,76%～90%为中度狭窄,91%～100%为重度狭窄;病变长度≥20mm为弥漫性病变。所有患者入院后均查血压、血常规,血清甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白(LDL-C)、血清肌酐(Cr)、尿素氮(BUN)、空腹血糖(FBG)、超声心动图等。
1.3分组
根据血浆BNP水平将患者分为三组,A组BNP ≤100ng/L,共33例,其中男性19例,女性14例;B组100ng/L2检验,P0.05)。
2.2三组患者疾病构成情况
见表2。
从表2可见,随着BNP水平的升高,STEMI患者例数逐渐上升,而NSTEMI和UA例数逐渐下降(PB组>A组,分析原因,可能是由于BNP水平越高,说明心肌缺血或坏死面积越大,受损心肌范围越广,致心肌收缩/舒张功能下降越明显,心室扩张、重构、充血性心力衰竭发生率增加,导致MACE上升。此外,本文研究中STEMI患者的比例C组>B组>A组,C组中一半以上的患者均为STEMI,且STEMI患者中BNP水平升高,其MACE发生率亦上升,提示BNP与STEMI患者的预后有一定关系。
综上所述,本文结果进一步显示血浆BNP水平对判断ACS患者的预后,尤其是对主要心脏不良事件的发生有很强的预测价值,值得临床进一步研究,建议对所有入院ACS患者常规检测BNP水平,以评价其预后。
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(收稿日期:2009-03-05)
