B-型钠尿肽系列测定判定急性冠脉综合征患者预后的价值  

Prognostic value of serial BNP measurements in patients with acute coronary syndromes

作　　者：张强[1] 梁凤焱[1] 杨玉香[1] 刘仲华[1] 

机构地区：[1]青岛大学医学院附属威海医院心内科,山东省264200

出　　处：《中国心血管病研究》2008年第4期261-263,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探索对急性冠脉综合征(ACS)患者,B-型钠尿肽(BNP)系列测定联合TnT、CRP与不良心脏事件发生率的关系。方法对83例ACS患者分别在入院时、48h、72h测定其BNP、TnT、CRP值,以死亡、心肌梗死、症状性心衰为随访终点,平均随访12个月,对BNP等生化指标与心脏事件发生率的相关性进行统计学分析。结果随访中发现,BNP>250ng/L的患者与BNP≤250ng/L的患者相比,心脏事件的发生率显著升高,为9%和27%(OR3.7,95%CI:2.3～5.7,P<0.01)。在TnT阴性的患者,高BNP组与低BNP组相比,其危险比为5.9(95%CI2.6～13.3,P<0.01)。在临床稳定、没有难治性心肌缺血的患者,BNP值快速下降,基线、48h、72h时的BNP值分别为248.6±10、188.9±8(-24%)、126.8±11(-49%),与基线相比,48h、72h差异均有统计学意义(P<0.01)。BNP在基线时水平较低,而在72h显著升高的患者,预后较差,OR值为24.0(95%CI:8.4～32.5,P<0.01)。而在基线时BNP值较高,72h时明显下降者,MACE发生率显著降低,与持续升高者相比,为16%vs38%(OR18.5,95%CI:7.6～21.3,P<0.01)。结论对ACS患者,BNP是一个强有力的预后判断指标,并且BNP的系列测定与单一基线水平测定相比,其预后判断价值显著增加。Objective To evaluate the relationship between serial BNP measurements and cardiovascular events in patients with acute coronary syndromes（ACS）. Methods BNP, troponin T（TnT） and C-reactive protein （CRP） were measured at baseline and at 48 and 72 hours in 83 patients with ACS. Death and myocardial infarction were recorded during 12 months of follow-up. Statistical analysis was done. Results For the later follow-up, baseline BNP levels higher were associated with higher event rates, event rates were significantly higher in patients with BNP〉250 ng/L than the patients with BNP≤250 ng/L （9% vs 27%,OR 3.7,95%CI：2.3-5.7,P〈 0.01）. In troponin T negative patients,BNP identified a subgroup of high-risk patients （OR,5.9,95% CI, 2.6 to 13.3,P〈0.01 ）. Importantly,clinical stabilization without refractory ischemia was associated with a rapid and significant （48 hours,-24%,72 hours , -49% , both P〈0.001 ） decline in BNP levels. In patients with high BNP baseline levels, lack of a rapid decline in BNP levels was linked to an adverse short-term prognosis（OR 18.5,95% CI：7.6 to 21.3 ,P〈0.01 ）. In patients with low BNP baseline levels, a rise in BNP levels over 72 hours was also linked to an adverse prognosis （OR 24.0,95% CI：8.4 to 32.5,P〈0.01）. Condusion BNP is a powerful and independent determinant of the short-term cardiac risk in patients with ACS, and serial BNP measurements are superior to a single BNP value obtained at baseline.

关 键 词：B-型钠尿肽 系列测定 急性冠脉综合征 预后 

分 类 号：R541.4[医药卫生—心血管疾病]