动态监测hs-CRP和NT-proBNP对急性心肌梗死的临床意义  

Clinical significance of dynamic monitoring of hs-CRP and NT-proBNP in acute myocardial infarction

作　　者：龚国忠[1] 刘友迎 蒲泽晏 黄刚[2] 涂建华[1] 李祥坤[1] 胡然[1] 杨瀚晅 

机构地区：[1]遂宁市中心医院检验科,四川遂宁629000 [2]遂宁市中心医院心内科,四川遂宁629000

出　　处：《国际检验医学杂志》2013年第8期930-931,933,共3页International Journal of Laboratory Medicine

基　　金：四川省卫生厅基金资助项目(100578)

摘　　要：目的采用高敏C反应蛋白(hs-CRP)和N末端B型脑钠肽前体(NT-proBNP)评估急性心肌梗死(AMI)患者的病情。方法选取2009年1月至2012年3月该院126例AMI患者为AMI组,90例健康体检者为对照组,测定NT-proBNP水平,比较不同Killip分级NT-proBNP水平的变化。选择90例AMI患者在4～10h、18～26h、40～52h、72～84h内做hs-CRP水平的动态测定。结果与对照组比较,AMI组KillipⅡ级、Ⅲ级、Ⅳ患者NT-proBNP水平均明显增高,两组比较差异有统计学意义(P<0.01)。KillipⅢ级、Ⅳ级患者的NT-proBNP水平明显高于KillipⅡ级患者,两者比较差异有统计学意义(P<0.01)。AMI患者的hs-CRP水平在发病4～10h内开始升高,病情好转组敏感度为77%,而病情加重组敏感度为89%,两组比较差异有统计学意义(P<0.01),且明显高于对照组(P<0.01)。在18～26h、40～52h的时间段,两组比较差异无统计学意义(P>0.01),而在72～84h两组病例敏感度差异有统计学意义(P<0.01)。4～10h、18～26h、40～52h、72～84h时间段里,病情好转组血清hs-CRP水平明显低于病情严重组,两者比较差异有统计学意义(P<0.01)。结论 AMI患者hs-CRP、NT-proBNP随病情加重进行性上升,病情好转时两者水平下降,而持续高水平时提示病情严重。动态监测hs-CRP、NT-proBNP对急性心肌梗死的病情评估有很大的价值。Objective To utilize high sensitivity C reactive protein（hs-CRP） and N-terminal pro B type natriuretic peptide （NT-proBNP） to evaluate acute myocardial infarction（AMI） patientsr condition. Methods From 2009 January to 2012 March, serum NT proBNP levels were measured in 90 patients with AMI and 90 healthy people as control group. Serum NT-proBNP levels were compared according to different Killip classes. Serum hs-CRP level in 126 patients with AMI were measured at 4-10 h,18-26 h,40 52 h,72-84 h. Results Compared with the control group,serum NT-proBNP level of the patients with Killip classes Ⅱ , Ⅲ and Ⅳ in myocardial infarction group was obviously higher,there were significant differences between the two groups （P〈0.01）. Killip Ⅲ , Ⅳ patients with NT-proBNP levels were significantly higher than that of Killip Ⅱ patients, there were significant differences between them （P〈0.01）. AMI patients with bs-CRP elevated in 4-10 h,the illness faster better group had a sensitivity of 77 %, and illness restructuring had a sensitivity of 89%, the differences were statistically significant （P〈 0. 01） , which were significantly highber than normal control group （P〈0.01）. In the period of 18-26 h, 40-52 h , two groups had no significant differences（P〉0. 01）. In the period of 72-84 h ,the differences were statistically significant between two groups （P〈0. 01）. In the period of 18-26 h, 40 52 h,72 84 h the serum concentrations of hs-CRP in the group of improved condition patients were significantly higher than the group of improved condition patients,there were significant differences between the two groups （P〈0.01） . Conclusion In pa- tickets with AMI the level of hs-CRP and NT-proBNP increases with aggravated condition, while they decease with improved condi-tion. And their persistent high level demonstrates patientst serious illness. There is a higher clinical value to dynamically monitor hs-CRP and NT-proBNP to evaluate AMI patients＇ condition.

关 键 词：心肌梗死 C反应蛋白质 利钠肽 脑 

分 类 号：R542.22[医药卫生—心血管疾病]