血清proBNP诊断冠心病的价值

目的 探讨血清脑钠尿肽前体（proBNP）浓度与冠脉病变严重程度的关系，并评价采用血清proBNP浓度诊断冠脉狭窄和急性冠脉综合征（ACS）的效能。方法 将163例患者根据冠脉造影结果分为非冠心病组（冠脉狭窄程度<50%）、冠心病冠脉狭窄单支组、双支组和多支组（冠脉狭窄程度≥50%）。另外根据冠心病的临床类型分为稳定型心绞痛（SAP）组、不稳定型心绞痛（UAP）组和急性心肌梗死（AMI）组。所有患者均测定血清proBNP浓度，并比较两种分组情况下各组血清proBNP浓度的差异。结果 单支组、双支组和多支组血清proBNP浓度高于非冠心病组（P<0.05），随冠脉狭窄支数增多，proBNP浓度增高。SAP组、UAP组、AMI组proBNP浓度高于非冠心病组，AMI组proBNP浓度高于SAP组和UAP组，UAP组proBNP浓度高于SAP组（均P<0.05）。血清proBNP浓度诊断冠脉狭窄的最佳截断值为94.01 ng/L，ROC曲线下面积为0.845，灵敏度73%，特异度89%。诊断ACS时最佳截断值为123.3 ng/L，ROC曲线下面积为0.850，灵敏度88%，特异度71%，系列联合试验检测proBNP和CK或CK-MB可提高特异度。结论 血清proBNP浓度对冠脉狭窄与ACS有较好的诊断效能。

Predictive value of serum proBNP concentration for coronary heart disease

AIM To investigate the association between serum proBNP concentration and the severity of coronary artery lesions and to evaluate the working efficiency of serum proBNP concentration in screening acute coronary syndrome (ACS) and coronary artery stenosis. METHODSOne hundred and sixty-three patients were enrolled in this study. All patients underwent coronary angiography (CAG) and were classified into four groups: non-coronary heart diseas (non-CHD) group (coronary artery stenosis <50%), single-vessel group, double-vessel group and multiple-vessel group (coronary artery stenosis >50%). Also, according to clinical manifestations and diagnoses, the patients were classified into stable angina group (SA group), unstable angina group (UAP group) and acute myocardial infarction group (AMI group). Serum proBNP concentrations were measured and compared between groups. RESULTSThe best cutoff value of proBNP in screening coronary artery stenosis was 94.01 pg/ml. The area under ROC curve was 0.845 and the sensitivity and the specificity were 73.1% and 88.9%. The positive predictive value was 98.2%. The best cutoff value of proBNP in screening ACS was 94.01 pg/ml. The area under ROC curve was 0.947 and the sensitivity and the specificity were 91.3% and 88.9%. The positive predictive value was 97.3%. The combined test of proBNP and CK or CKMB improved the specificity. Serum proBNP concentrations in multiple-vessel group, double-vessel group and single-vessel group were significantly higher than those in control group (P<0.05) and was different between any two groups (P<0.05). The higher the number of stenosed vessels, the higher the serum proBNP concentration. Moreover, proBNP concentration in AMI group was significantly higher than in other groups (P<0.05). proBNP concentration in UA group was higher than in SA group and control group (P<0.05) and proBNP concentration in SA group was markedly higher than in control group (P<0.05). CONCLUSIONSerum proBNP concentration is related to the severity of coronary artery lesions and has high value in screening coronary artery stenosis and ACS patients.