N T-proBNP 在判断 ACS 患者冠状动脉病变程度和短期预后中的价值

目的：通过检测急性冠状动脉综合征（ACS）患者血清 N 端脑钠肽前体（NT-proBNP）的水平变化，观察其对评估ACS 患者冠状动脉病变严重程度和预后的诊断价值。方法选取2013年1月至2014年12月入住南通大学附属医院心内科ACS 患者作为观察对象，其中，不稳定心绞痛患者64例，非 ST 段抬高性心肌梗死患者46例，急性 ST 段抬高性心肌梗死患者22例。将其分为高 NT-proBNP 组（≥474 pg／mL）和低 NT-proBNP 组（＜474 pg ／mL），心脏超声检测并比较各组患者射血分数；冠状动脉造影术检测两组患者冠状动脉病变情况，血清学检测两组患者心肌肌钙蛋白 I（cTnI）、肌酸激酶同工酶（CK-MB）、C-反应蛋白（CRP）和 NT-proBNP ，计算两组患者平均住院时间和心力衰竭、心源性休克发生率。结果 ACS 患者血清 NT-proBNP 和射血分数呈负相关。高 NT-proBNP 组患者心力衰竭发生率和住院天数明显高于低 NT-proBNP 组；高 NT-proBNP 组在冠状动脉病变支数、冠状动脉狭窄度方面均高于低 NT-proBNP 组；高 NT-proBNP 组 TIMI 血流分级低于低 NT-proBNP 组，差异有统计学意义（P＜0．05）。结论 NT-proBNP 作为判断 ACS 患者冠状动脉病变程度和短期预后的可靠指标值得临床进一步推广。

Value of NT-proBNP in predicting severity of coronary artery disease and prognosis in acute coronary syndrome

Objective To assess the in-hospital prognostic value of NT-proBNP in patients with acute coronary syndrome (ACS) and its relation to the severity and prognosis of coronary artery disease .Methods Totally 132 consecutive patients with ACS in Affiliated Hospital of Nantong University from January 2013 to December 2014 were collected in this study ,in which 64 pa-tients with unstable angina(UA) ,46 patients with non-ST segment elevation myocardial infarction(NSTEMI) ,and 22 patients with ST segment elevation myocardial infarction(STEMI) .Patients were divided into two high NT-proBNP group(NT-proBNP ≥ 474 pg/mL) and low NT-proBNP group(NT-proBNP < 474 pg/mL ) .Ejection fraction were detected and compared between the two groups ,coronary artery disease were detected by coronary angiography .cTnI ,CK-MB ,CRP and NT-proBNP were detected by sero-logical ,and the average length of hospital stay and heart failure ,cardiac shock incidence were calculated .Results There was a sig-nificant negative correlation between NT-proBNP and ejection fraction .Incidence of heart failure and duration of hospital stay in high NT-proBNP group were significantly higher than in low NT-proBNP group ;The number of coronary vessels affected ,severity of stenosis and proximal left anterior descending artery(LAD) disease in high NT-proBNP group were higher than in low NT-proB-NP group ;TIMI flow grade was significantly lower in high NT-proBNP group than in low NT-proBNP group ,the difference was statistically significant(P< 0 .05) .Conclusion NT-proBNP is a valuable marker for predicting prognosis and severity of coronary artery disease in patients with acute coronary syndrome .