血浆cTnI、CK-MB及BNP水平在急性胸痛患者中的变化及临床意义

目的探究血浆心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)水平在急性胸痛患者中的变化及临床意义。方法选择2016年1月至2019年1月我院收治的以急性胸痛为首发症状的患者作为研究对象,其中急性心肌梗死(AMI)患者59例,不稳定心绞痛(UAP)患者42例,稳定型心绞痛(SAP)患者38例,另39例患者经检查冠脉未见明显异常,纳入对照组。收集患者临床资料,采用GRACE评分工具进行危险分级,测定血浆cTnI、CK-MB及BNP水平。结果SAP、UAP、AMI组患者高脂血症患病率显著高于对照组(P<0.05),左心射血分数(LVEF)显著低于对照组(P<0.05),血浆cTnI、CK-MB、BNP水平高于对照组(P<0.05);ROC曲线示,血浆cTnI、CK-MB、BNP指标诊断心源性胸痛的曲线下面积分别为0.834、0.792、0.892,各指标联合诊断的曲线下面积为0.935;随着危险程度的升高,血浆cTnI、CK-MB、BNP水平升高(P<0.05);Pearson相关性分析示,血浆cTnI、CK-MB、BNP与LVEF呈负相关(P<0.05),与冠脉病变支数、GRACE评分呈正相关(P<0.05)。结论心源性胸痛患者可出现血浆cTnI、CK-MB、BNP等水平的升高,且升高幅度与病情严重程度相关,临床上可将其作为诊断高危性缺血性疾病的参考指标。

Changes in Levels of Plasma cTnI,CK-MB and BNP in Patients with Acute Chest Pain and Their Clinical Significances

Objective To explore changes in levels of plasma cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)and brain natriuretic peptide(BNP)in patients with acute chest pain and their clinical significances.Methods During the period from January,2016 to January,2019,patients who were admitted to the hospital with acute chest pain as the first symptom were enrolled for the study,including 59 cases with acute myocardial infarction(AMI),42 cases with unstable angina pectoris(UAP)and 38 cases with stable angina pectoris(SAP).There were 39 cases without obvious coronary artery abnormalities who were included into the control group.The clinical data of all patients were collected.The risk grading was conducted by GRACE scoring tools.The levels of plasma cTnI,CK-MB and BNP were measured.Results The prevalence of hyperlipidemia in SAP,UAP and AMI groups were significantly higher than that in the control group(P<0.05),while left ventricular ejection fraction(LVEF)was significantly lower than that in the control group(P<0.05),and levels of plasma cTnI,CK-MB and BNP were higher than those in the control group(P<0.05).ROC curve showed that areas under the curve(AUC)of plasma cTnI,CK-MB and BNP for the diagnosis of cardiogenic chest pain were 0.834.0.792 and 0.892,respectively.The area under the curve for joint diagnosis of all three indicator was 0.935.With the increase of risk level,levels of plasma cTnI,CK-MB and BNP were increased(P<0.05).Pearson correlation analysis showed that plasma cTnI,CK-MB and BNP were negatively correlated with LVEF(P<0.05),while positively correlated with number of coronary artery lesions and GRACE score(P<0.05).Conclusion The levels of plasma cTnI,CK-MB and BNP are increased in patients with cardiogenic chest pain.And the scale of the increase is related to disease severity.Clinically,they can be applied as reference indexes for diagnosis of high-risk ischemic diseases.