B型尿钠肽对无ST段抬高急性心肌梗死患者的诊断价值

目的:评价B型尿钠肽(BNP)对伴急性胸痛但心电图无ST段抬高的急性心肌梗死(AMI)患者的诊断价值。方法:对156例门诊及急诊急性胸痛或胸部不适患者进行前瞻性研究,测定BNP和肌钙蛋白I(cTnI),评价BNP对无ST段抬高的AMI患者的早期诊断价值。结果:156例患者中,不伴有心电图ST段抬高AMI患者,其入院时BNP水平显著高于不稳定型心绞痛和非急性冠状动脉综合征患者。BNP诊断无ST段抬高的AMI的敏感度为0.63,特异度为0.42。联合应用BNP及cTnI可显著提高对无ST段抬高AMI的诊断敏感度(0.99),阴性预测值可提高至0.98。经多元回归分析发现,对于诊断无ST段抬高AMI,BNP是一个显著的独立指标。结论:对于伴有急性胸痛但无ST段抬高的AMI患者,尤其是cTnI还未达到AMI诊断阈值时,BNP联合cTnI可能成为其有效的早期诊断指标之一。

Diagnostic value of B-type natriuretic peptide in the acute myocardial infarction patients without ST segment elevation

Objective To investigate the diagnostic value of B-type natriuretic peptide(BNP) in the acute myocardial infarction(AMI) patients with chest pain but without ST-segment elevation. Methods A prospective study involving 156 patients with chest pain or chest indisposition was conducted in the out-patient department and the emergency department. The concentrations of BNP and cardiac troponin I(cTnI) were evaluated at their admission. Results Ninety-four patients had AMI without ST elevation, whose BNP level at their admission was significantly higher than that of the patients with unstable angina or non-acute coronary syndrome. The sensitivity and the specificity of BNP for non-ST AMI were 0.63 and 0.42, respectively. BNP in combination with cTnI significantly elevated the sensitivity of diagnosis to 0.99, and the negative predictive value to 0.98. Multiple logistic regression analysis showed that BNP at the patieats' admission was a significant independent predictor for non-ST AMI. Conclusions BNP at the patieats' admission is possibly a useful and competent predictor for AMI patients with chest pain but without ST segment elevation, especially for patients whose cTnI value is just beyond the upper limit of normal range but still under the cutoff value.