急性心肌梗死患者Mb,TnI,BNP和HCY水平变化与临床分析

目的 :为观察急性心肌梗死 (AMI)患者血清中肌红蛋白 (Mb)、肌钙蛋白I(TnI)、脑钠肽 (BNP)、同型半胱氨酸 (HCY)水平动态变化和AMI治疗前后的水平变化 ,并探讨AMI发病机制 ,为诊断、治疗及预后判断提供依据。方法 :应用化学发光、酶联免疫分析的方法 ,对 5 4例AMI患者治疗前后和 30名对照者血清中的Mb、BNP、TnI和HCY水平进行检测。结果 :AMI患者四项指标明显高于对照组 (P <0 0 1) ;AMI患者经溶栓治疗后 ,血清中四项指标明显下降 ,与治疗前比较有显著性差异 (P <0 0 1) ;在AMI治疗前后BNP与Mb水平变化呈正相关 (r1=0 .874 ,r2 =0 .5 14 ) ,TnI与HCY水平变化呈正相关 (r3 =0 .75 1,r4=0 .4 6 8) ;但AMI经溶栓治疗后Mb水平恢复至正常水平 (P >0 0 5 ) ,而BNP、TnI和HCY水平虽然下降明显 ,但与对照组比较仍有明显差异 (P <0 0 5 ) ;在其动态变化提示 ,AMI早期以检测HCY、TnI为佳 ,中期以检测Mb、BNP为佳 ,末期以TnI、BNP检测为佳。结论 :AMI患者血清中Mb、BNP、TnI和HCY水平的动态变化说明参与了AMI的发生、发展 ,并提示四项指标在AMI患者发病过程中不同阶段有其不同的诊疗价值 ,从而为AMI的诊断、治疗、预后判断提供了新的理论依据。

Dynamic Changes of Plasma Mb,TnI, BNP and HCY Levels in Patients with AMI

Objective To investigate the dynamic changes of plasma myoglobin (Mb), troponin I (TnI), brain natriuretic peptide (BNP) and homocysteine (HCY) levels in the course of acute myocardial infarction (AMI) and to detect the best markers for early diagnosis and outcome prediction. Methods Plasma Mb,TnI, HCY (with chemiluminescence assay) and BNP (with ELISA) levels were measured in 54 patients with AMI both before and after thrombolysis therapy and 30 controls. Multiple measurcements of these markers were performed in the first three days after the cardiac event and measurements were done less frequently thereafter. Results Plasma levels of all these 4 markers were significantly higher in the AMI patients at admission than those in the controls (P<0.01). After thrombolysis therapy, levels of these markers dropped significantly (vs before treatment, P<0.01). The Mb levels fell to approximately normal (P>05); the others remained higher than normal (vs controls, P<0.05). BNP and Mb levels were positively correlated (before treatment r=0.874, after treatment r=0.514). Positive correlation also existed between TnI and HCY (r=0.75, r=0.468). Data from multiple measurements suggested that the best markers for assessing the disease process were: early phase TnI, HCY; middle phase Mb, BNP; late phase TnI, BNP. Conclusion Dynamic study of the changes of the plasma levels of these four markers confirms the usefulness of measurements of the markers for early diagnosis and monitoring of patients with AMI. The relative importance of individual markers at different phases of the disease process is also described.