血氨基末端脑钠肽前体对急性心肌梗死远期心功能的评估价值

目的观察血氨基末端脑钠肽前体（NT-proBNP）对急性心肌梗死患者的远期预测价值。方法本研究入选了58例发病24h以内ST段抬高的急性心肌梗死患者。所有病例既往均无明显心功能不全临床表现。于入院即刻、24h及1周测NT-proBNP,高敏C反应蛋白（HS-CRP）,随访1年的病死率、心血管事件住院率及心力衰竭住院率,并于1年后复查超声心动图。结果所有急性心肌梗死患者的NT-proBNP峰值均高于正常,高峰见于入院24h。一年随访中病死率、所有心血管事件住院率和心力衰竭住院率分别为6.9%、20.7%和13.8%。死亡病例、所有心血管事件住院病例和因心力衰竭住院病例研究入组时的NT-proBNP峰值均高于其余病例。发生心血管事件病例研究入组时的HS-CRP峰值也高于其余病例,但仅在死亡病例中有统计学意义。在急性心肌梗死病例中,研究入组时的血NT-proBNP峰值与1年后的左室射血分数值（r=0.383,P=0.003）及左室舒张末期直径（r=0.280,P=0.035）呈线性相关关系。结论高NT-proBNP的急性心肌梗死患者容易再发急性心血管事件,并且与远期心力衰竭的发生密切相关。

Long-term prognostic value of N-terminal pro-brain natriuretic peptide level in acute myocardial infarction

Objective To observe long-term prognostic value of N-terminal pro brain natriuretic peptide （NT-proBNP） in acute myocardial infarction （AMI） patients. Methods Fifty-eight patients were enrolled in this study. All of them suffered from AMI within 24 h and had no heart failure history. NT-proBNP and high sensitivity C reactive protein（HS-CRP） were examined at 0h, 24h and 1 week after admission in all cases. Echocardiogram was also examined during the 7th to 10th days of hospitalization. Results NT-proBNP concentration was high in all AMI patients and increased rapidly to peak at 24 h. During 1 year follow-up, 4（6. 9 % ） , 12 （20. 7 % ） and 8 （13.8 %） patients died, hospitalized due to all cardiovascular events and heart failure respectively. In patients who died or were hospitalized due to all cardiovascular events and heart failure, the peak NT-proBNP concentration was higher than others when they were enrolled, but high HS-CRP concentration was only seen in dead cases. One year follow-up examination found that left ventrieular ejection fraction and left ventrieular diameter were correlated to their peak NT-proBNP concentration. Conclusion NT-proBNP can predict mortality and cardiovascular event in AMI patients, and its prognostic value may be better than that of HS-CRP. It is also a good predictor of long-term heart failure.