B型脑钠肽、D-二聚体、超敏C反应蛋白检测在老年急性冠状动脉综合征中的应用

目的探讨老年急性冠状动脉综合征(ACS)中血浆B型脑钠肽(BNP)、D-二聚体(D-D)和超敏C反应蛋白(hs-CRP)水平的变化及其与预后的关系。方法 118例老年ACS患者按临床类型分为:急性心肌梗死(AMI)组60例,不稳定型心绞痛(UAP)组58例,同期入选体检健康者45例作为对照组。检测各组血浆BNP、D-D和hs-CRP值及超声心动图检测左心室射血分数(LVEF),比较各组三指标间的差异;AMI组患者根据Killip分级行心功能分级,同时按BNP水平分为四个等级,比较分析Killip心功能分级与BNP水平的关系;所有患者平均随访1年,观察随访期间的药物治疗和主要不良临床事件的发生率。结果 AMI组血浆3项指标明显高于UAP组(P<0.05),UAP组明显高于对照组(P<0.05);AMI组中,Killip分级Ⅱ^Ⅳ级者共35例,按BNP水平分级2Ⅳ级者共35例,按BNP水平分级2⁴级者分别为7、12、16例,BNP水平4级患者数与其他三组相比,差异明显(P<0.05);BNP水平3级与1、2级相比,差异有统计学意义(P<0.05)。BNP、D-D均升高者发生不良临床事件的次数明显高于都正常者(P<0.05);BNP、D-D中仅一项高的患者组比较略有差异,无统计学意义(P>0.05)。结论 BNP、D-D和hs-CRP的水平反映心肌缺血损伤的程度,联合分析有助于老年ACS患者的临床诊断、危险分层及预后评估。

Clinical value of brain natriuretic peptide,D-dimer and high sensitive C-reactive protein in elderly acute coronary syndrome

Objective To investigate the changes of b-type brain natriuretic peptide （BNP）, D-dimer（D-D） and hypersensitive C-reactive protein （hs-CRP） in plasma levels of the elderly acute coronary syndrome （ACS） of and its relationship with prognosis.MethodsThe total of 118 elderly ACS by clinical types were enrolled, include： acute myocardial infarction （AMI） group of 60 cases, unstable angina （UAP） group of 58 cases, and the healthy control group of 45 cases. Plasma levels of BNP, D-D and hs-CRP were detected, and left ventricular ejection fraction（LVEF） were detected by ultrasonic cardiogram; the clinical significances of BNP in every group were analyzed. The AMI patients according to the grade of cardiac function, Killip classification line, and the BNP levels can be divided into four grades, Killip cardiac function classification are compared with those of the BNP level. All patients were followed up for 1 year on average, to observe the follow-up period of drug therapy and the incidence of major adverse cardiac events （MACE）.Results Plasma levels of BNP, hs-CRP, D-D in AMI group were significantly higher than those in UAP group（P〈0.05）, and in UAP group were significantly higher than those in control group （P〈0.05）. In AMI group, Killip classⅡ-Ⅳ 21 cases and 14 cases respectively, Compared with the＆amp;nbsp;four levels of BNP and the other three groups had significantly（P〈0.05）. Compared with the three levels of BNP and the one, two levels of BNP had significantly（P〈0.05）. The numbers of adverse clinical events in the elevated individual of BNP, D-D was higher than the individual of normal（P〈0.05）, and only a high of BNP, D-D in patients was slightly different（P〉0.05）.Conclusion The levels of BNP D-D and hs-CRP react degree of myocardial ischemia damage, conjoint analysis can be used as a clinical diagnosis, risk stratification of elderly ACS and prognosis judgement of a noninvasive quantitative indicators.