BNP对于ACS的早期诊断价值及其与心肌坏死标志物的相关性

目的：探讨血清脑利钠肽（BNP）对于急性冠脉综合征（ACs）患者的早期诊断价值以及与心肌坏死标志物的相关性。方法：入选ACS患者63例（ACS组），健康体检者22例（健康对照组）。ACS组被分为急性心肌梗死（AMI）组（25例）和不稳定型心绞痛（UAP）组（38例）；根据累及冠状动脉病变血管数量将其中45例ACS患者分为单支病变组（10例）、双支病变组（14例）、三支及以上病变组（21例）。检测各组BNP、肌钙蛋白I（cT—nI）、肌酸激酶-同工酶（CK—MB）水平。结果：（1）与健康对照组比较，UAP组和AMI组BNP水平明显升高（27．68±7．54）pg／ml比（48．59±146．30）pg／ml比（277．99±179．57）pg／ml，P〈0．013；ACS患者多支病变组BNP水平明显高于双支及单支病变组（308．17±178．94）pg／ml比（187．35±156．27）pg／ml比（68．36±47．76）pg／ml，P〈0．05-〈0．013，双支病变组BNP水平明显高于单支病变组（P〈0．05）；（2）ACS患者胸痛发作6h内，BNP、CK—MB水平明显高于健康对照组（P〈0．01），而cTnI无显著变化（P〉0．05）；胸痛发作6～24h内，与健康对照组比较，ACS组BNP（27．68±7．54）pg／ml比（280．45±155．27）pg／ml]、cTnI（0．05±0．03）ng／ml比（10．45±4．01）ng／ml]、CK—MBE（6．79±1．42）U／L比（64．64±37．05）U／L]水平均明显升高（P〈0．01）；直线相关分析显示BNP与eTnI、CK—MB呈正相关性（r=0．517，P=0．000；r=0．483，P=0．001）。结论：血清脑利钠肽水平与心肌缺血损伤严重程度及冠脉病变支数相关，对于急性冠脉综合征的早期诊断有临床应用价值。

Diagnostic value of BNP in early ACS and its relationship with markers of myocardial necrosis

Objective:To study diagnostic value of serum brain natriuretic peptide(BNP) in patients with early acute coronary syndrome(ACS),its correlation with markers of myocardial necrosis.Methods:A total of 63 ACS patients(ACS group) and 22 healthy subjects(healthy control group) were enrolled.ACS group was divided into acute myocardial infarction(AMI) group(n=25) and unstable angina pectoris(UAP) group(n=38);according to number of disease coronary vessels,a total of 45 ACS patients were divided into single-vessel coronary disease group(single-vessel group,n=10),double-vessel coronary disease group(double-vessel group,n=14) and multiple-vessel coronary disease group(multiple-vessel group,n=21).Levels of BNP,cardiac troponin I(cTnI) and creatine kinase isoenzyme(CK-MB) were measured in all groups.Results:Compared with healthy control group,there was significant increase in BNP level in UAP group and AMI group (27.68±7.54) pg/ml vs.(48.59±146.39) pg/ml vs.(277.99±179.57) pg/ml,P<0.01];BNP level of ACS multiple-vessel group was significantly higher than those of double-vessel group and single-vessel group (308.17±178.94) pg/ml vs.(187.35±156.27) pg/ml vs.(68.36±47.76) pg/ml,P<0.05～<0.01],and that of double-vessel group was significantly higher than that of single-vessel group(P<0.05);Within 6h after onset of chest pain,levels of BNP and CK-MB in ACS group were significantly higher than those of healthy control group(P<0.01),but cTnI level was not significant difference(P>0.05);within 6～24h after onset of chest pain,compared with healthy control group,there were significant increase in levels of BNP (27.68±7.54) pg/ml vs.(280.45±155.27) pg/ml]、cTnI (0.05±0.03) ng/ml vs.(10.45±4.01) ng/ml]、CK-MB (6.79±1.42) U/L vs.(64.64±37.05) U/L] in ACS group,P<0.01 all;Linear correlation analysis indicated that BNP was positively correlated with cTnI and CK-MB(r=0.517,P=0.000;r=0.483,P=0.001).Conclusion:Serum level of BNP is related with severity of myocardial ischemic damage and number of disease coronary vessels.It possesses clinical value in early diagnosis.