急性冠脉综合征并糖尿病老年患者血清BNP与不良心血管事件的相关性

  目的 探讨血清B型尿钠肽(b-type natriuretic peptide,BNP)水平与急性冠状动脉综合征(acute coronary syndrome,ACS)并糖尿病患者预后不良心血管事件发生率的相关性。 方法 对医院的221例ACS合并糖尿病的住院患者进行回顾性分析,所有患者入院时行BNP、心脏彩超、冠脉造影,并评价患者心功能,然后按照BNP水平分为升高组(≥100 pg/ml)、正常组(＜100 pg/ml)。比较BNP升高患者BNP水平与心功能分级、射血分数、冠脉病变严重程度相关性,并于发病后2、6、12个月对患者进行随访,随访的指标包括死亡、心血管事件发生情况(ACS再入院、充血性心力衰竭),然后比较两组患者结局指标的不同。 结果 (1)144例中,心功能Ⅱ级48例,BNP浓度为(223.0±89.1) pg/ml,LVEF为(60.3±8.3)%,冠脉病变程度Gensin评分(27.4±10.8)分;心功能Ⅲ级52例,BNP浓度为(423±125.5 )pg/ml,LVEF为(46.5±7.4)%,冠脉病变程度Gensin评分(56.5±18.4分);心功能Ⅳ级44例,BNP浓度为(665.0±157.5)pg/ml,LVEF为(35.0±4.5)%,冠脉病变程度Gensin评分83.1±29.7分。不同级别(Ⅱ-Ⅳ级)心功能患者BNP 水平、LVEF、冠脉病变程度比较,差异有统计学意义(P<0.05); BNP水平与左室射血分数(LVEF)呈高度负相关,与冠脉病变程度及心功能分级呈显著正相关。(2)发病后2、6、12个月死亡人数、再发心梗人数,差异无统计学意义,心力衰竭再住院人数比较,差异有统计学意义(P＜0.05)。应用Kaplan-Meier分析,对比两组患者生存率,发现BNP升高组生存率明显高于BNP正常组(P=0.019)。 结论 血清BNP水平能够作为病情判断及预测ACS合并糖尿病患者远期不良心血管事件发生的指标。

Correlations between serum BNP levels and adverse cardiovascular events in elderly patients with acute coronary syndrome and diabetes mellitus

Objective To investigate the correlations between serum BNP levels and the incidence of adverse cardiovascular events in patients with diabetes complicated with acute coronary syndrome.Methods Clinical data on 221 patients with acute coronary syndromes complicated with diabetes mellitus treated in our hospital was retrospectively analyzed, All these patients had their levels of BNP detected and received cardiac ultrasound and coronary angiography. The cardiac function of the patients was evaluated before they were divided into the ascending group (>100 pg/ml) and normal group (<100 pg/ml) according to BNP levels. The correlations between elevated BNP levels and cardiac function grading, ejection fraction and coronary artery lesion severity were investigated. Follow-up was conducted two months, six months and 12 months after the onset, involving such indexes as mortality and cardiovascular events before the difference in outcome indicators were compared between the two groups.Results (1) Among the 144 cases of patients with elevated BNP, there were 48 cases of cardiac function grade Ⅱ, the BNP concentration was (223.0±89.1)pg/ml, LVEF was (60.3±8.3)%, and the Gensin score of coronary artery lesions was(27.4±10.8) points. Among the 52 cases of cardiac function grade Ⅲ, the BNP concentration was(423±125.5 )pg/ml, LVEF was (46.5±7.4)%, and the Gensin score of coronary artery lesions was (56.5±18.4). Among the 44 cases of cardiac function grade Ⅳ, the BNP concentration was (665.0±157.5) pg/ml, LVEF was (35.0~4.5)%, and the Gensin score of coronary artery lesions was(83.1±29.7)points. The difference in LVEF and BNP levels and in coronary artery lesion severity was statistically significant between patients of different grades of cardiac function. The BNP level was negatively correlated with LVEF, which was positively correlated with the severity of coronary artery disease and cardiac function. (2) There was no statistically significant difference in the death toll or the number of patients with recurring myocardial infarction 2, 6 months and 12 months after the onset, but there was statistically significant difference in the number of inpatients due to recurring myocardial infarction. Kaplan-meier analysis showed that the survival rate of the ascending group was significantly higher than that in the normal group(P=0.019).Conclusions Serum BNP levels can be used as an indicator for the diagnosis and prediction of long-term adverse cardiovascular events in diabetic patients with acute coronary syndrome.