急诊快速检测急性冠脉综合征患者NT—proBNP水平的临床应用价值  

The clinical value of detecting the N - terminal pro - B - type natriuretic peptide in patients withacute coronary syndrome in the emergency department

作　　者：苏琴[1] 袁晓玲[1] 刘红升[1] 秦宇红[1] 张建波[1] 陈春鸣[1] 党伟[1] 张宪[1] 姚咏明[1] 赵晓东[1] 

机构地区：[1]首都地区军队急救中心解放军总医院第一附属医院急救部,北京100048

出　　处：《中国急救医学》2013年第2期124-127,共4页Chinese Journal of Critical Care Medicine

基　　金：国家重点基础研究发展规划项目

摘　　要：目的通过床旁快速检测急性冠脉综合征（ACS）患者血浆氨基末端脑钠肽前体（NT—proBNP）水平，探讨其在急诊ACS中早期诊断及危险分层的临床意义。方法所有ACS急诊患者来院后立即检测血浆NT—proBNP和cTnI水平，同时行床旁超声心动图检查，测定左心室射血分数（LVEF），并对急性心肌梗死（AMI）患者进行心功能Killip分级。ACS患者共113例，其中sT段抬高性急性心肌梗死（STEMI）组53例、非sT段抬高性急性心肌梗死（NSTEMI）组25例、不稳定型心绞痛（UA）组35例，选择正常对照组26例。比较各组血浆NT—proBNP水平及其与cTnI的相关性，分析74例AMI患者NT—proBNP水平与LVEF及心功能Killip分级的相关性。结果STEMI和NSTEMI组血浆NT—proBNP水平明显高于uA组，UA组高于正常对照组（P值均〈0．01）；各组NT—proBNP水平与cTnI呈正相关（r=0．417，P〈0．01）；AMI患者血浆NT—proBNP水平与心功能Killip分级呈正相关（r=0．396，P〈0．05），与LVEF呈负相关（r=-0．476，P〈0．01）。结论急诊快速检测NT—proBNP水平，可早期对ACS患者进行危险分层，并可作为心肌缺血范围及左心功能受损严重程度的重要指标。Objective To evaluate the clinical significance of a rapid testing method for N - terminal pro- B- type natriurietie peptide （NT -proBNP） level in ACS patients for early diagnosis of acute coronary syndrome （ACS） and risk stratification in the emergency department. Methods All emergency ACS patients were tested for the plasma level of NT - proBNP and cTnI, and examined with echoeardiography to determine the left ventrieular ejection fraction （LVEF） value. Acute myocardial infarction （AMI） patients were ranked by KiUip classification. Among 113 ACS patients tested, 53 patients have ST segment elevation myocardial infarction （ STEMI）, 25 patients have non - ST segment elevation myocardial infarction （ NSTEMI）, and 35 patients have unstable angina （ UA ）. The normal control group contains 26 cases. The NT - proBNP level was compared among groups to determine if there is any significant difference, and if there is correlation with the cTnI level. The correlation of the NT- proBNP level with LVEF value and Killip classification were also studied in 74 AMI patients. Results The NT - proBNP level in the STEMI and NSTEMI group （2173. 19±902.36 ng/L and 1738. 13±621.71 ng/L, respectively） were higher than that in the UA group （653.04±162.27 ng/ L）, which is higher than that in the control group （ 127.00 ±94.45 ng/L, P 〈 0.01 ）. There was apositive correlation between NT- proBNP level and cTnl（ r = 0.417, P 〈 0.01 ）in all groups tested. In AMI patients, there was a positive correlation between NT - proBNP level and Killip classification （ r = 0396, P 〈 0. 05 ）, and a negative correlation between NT - proBNP level and LVEF value （r = - 0. 476, P 〈 0. 01 ）. Conclusion The rapid testing method for NT - proBNP could be applied to early risk stratification of ACS patients. It could also be used as an important indicator for myocardial ischemia and for the severity of left ventricular dysfunction.

关 键 词：急性冠脉综合征(ACS) 氨基末端脑钠肽前体(NT—proBNP) 心肌肌钙蛋白I(cTnI) 左室射血分数(LVEF) 心功能Killip分级 

分 类 号：R541.4[医药卫生—心血管疾病]