N末端脑钠肽前体与超敏C反应蛋白联合检测在评估急性心肌梗死危险度中的应用  

Application of N-terminal B-type natriuretic peptide and hypersensitive C-reactive protein in assessing the risk of acute myocardial infarction

作　　者：王丽娟[1] 白宏兴 张晓燕[2] 拓胜军[1] 武治东 陈娟 WANG Li-juan;BAI Hong-xing;ZHANG Xiao-yan(Department of Cardiovascular Medicine,Yan＇an People＇s Hospital,Yan＇an 716000,China)

机构地区：[1]延安市人民医院心血管内科,陕西省延安市716000 [2]延安市人民医院呼吸内科,陕西省延安市716000 [3]延安市人民医院医技科,陕西省延安市716000

出　　处：《中国心血管病研究》2018年第10期920-923,共4页Chinese Journal of Cardiovascular Research

基　　金：延安市科学技研究发展计划项目(项目编号:2015KM-03)

摘　　要：目的通过联合检测急性心肌梗死（AM[）患者N末端脑钠肽前体（NT-proBNP）及超敏C反应蛋白（hs—CRP）水平,分析其与不良心血管事件发生率及冠状动脉血管病变程度的相关性，对急性心肌梗死危险度进行早期评估。方法选取2015年2月至2017年10月我院收治的AMI患者185例，其中急性ST段抬高型心肌梗死（STEMI）患者95例、急性非ST段抬高型心肌梗死（NSTEMI）患者90例，选取同期22例冠状动脉造影正常者为对照组，联合检测NT-proBNP、hs—CRP水平，记录24小时、1周、1个月、6个月内不良心血管事件（MACE）发生情况，对比分析不同水平NT-proBNP、hs—CRP患者的MACE发生率及其与冠状动脉病变程度相关性。结果STEMI组、NSTEMI组血浆NT—proBNP、hs-CRP水平均高于对照组（P〈0．05），STEMI组与NSTEMI组之间比较未见统计学差异（P〉0．05）；NT-proBNP、hs—CRP水平多支病变组〉双支病变组〉单支病变组〉对照组（P〈0．05），NT-proBNP、hs-CRP水平与Gensini积分呈正相关（r=0．678、0．814，P〈0．05）；NT-proBNP、hs-CRP对终点事件预测cut—off值分别为960pg／ml、6mg／L（AUC：0．952、0．891，P〈0．05），MACE发生率方面高NT-proBNP、高hs—CRP组〉高NT-proBNP、低hs—CRP组〉低NT-proBNP、高hs—CRP组〉低NT—proBNP、低hs—CRP组（P〈0．05）。结论AMI患者冠状动脉病变程度、MACE发生率与NT-proBNP、hs—CRP水平有一定相关性，可作为急性心肌梗死危险度早期评估指标。Objective To explore the expression of NT-proBNP and hs-CRP levels in patients with acute myocardial infarction （AMI）, and the correlation between them and the incidence of cardiac events. Methods A total of 185 patients with AMI from February 2015 to October 2017 were selected, 95 patients with acute ST- elevation myocardial infarction and 90 patients with acute non-ST-segmant elevation myocardial infarction. Twenty-two patients with normal angiography were selected as the control. The levels of NT-proBNP and hs-CRP were measured. The occurrence of cardiac events （sudden death, heart failure and revascularization） at 24 hours, 1 week, 1 month and 6 months were recorded. The incidence of cardiac events at different levels of NT-proBNP and hs-CRP and their correlation with severity of coronary lesions were analyzed. Results NT-proBNP, hs-CRP levels in STEMI group and NSTEMI group were higher than those in control group （P〈0.05）. There was no significant difference between STEMI group and NSTEMI group （P〉0.05）. NT-proBNP, hs-CRP levels in multi- vessel disease group were higher than those in double-vessel disease group, which were higher than those in single vessel disease group （P〈0.05）. The levels of NT-proBNP and hs-CRP were positively correlated with Gensini scores （r=0.678, 0.814, P〈0.05 ）. The predicted cut-off values of NT-proBNP and hs-CRP for endpoint were 960 pg/ml, 6 mg/L（AUC： 0.952, 0.891, P〈0.05）. MACE incidence in high-NT-proBNP and high-hs-CRP group was higher than that in high-NT-proBNP and low-hs-CRP group, which was higher than that in low-NT-proBNP and high-hs-CRP group, low-NT-proBNP and low-hs-CRP group. Conclusion The results show that the degree of coronary artery disease and the incidence of adverse cardiac events in AMI patients are correlated with the levels of NT-proBNP and hs-CRP. NT-proBNP, hs-CRP can be used as early assessment of the risk of acute myocardial infarction.

关 键 词：急性心肌梗死 N末端脑钠肽前体 超敏C反应蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]