血浆脑钠肽在急性冠状动脉综合征中的意义

目的 研究脑钠肽(BNP)在急性冠状动脉综合征(ACS)中的临床意义.方法 选择2006年5月至2008年6月间我院住院的急性冠状动脉综合征患者151例,同期住院的高血压患者212例为对照组.均常规检测血脂、血糖、血常规、肾功能、超敏C-反应蛋白、脑钠肽(BNP);并记录患者血压、心率、吸烟史及高血压、糖尿病、高血脂等病史;同时检测常规心脏超声.结果 ACS组与对照组在年龄(69.0±10.9)与(62.0±14.2)岁,t=5.043,P＜0.001]、血肌酐(95.0±67.4)与(72.8 4-29.0) μmol/L,t=4.164,P＜0.001]、血尿酸(360.2±104.4)与(300.8±92.7) μmol/L,t=5.521,P＜0.001]、BNP(80.81与352.38 ng/L,Z=-7.295,P＜0.001)、hs-CRP(7.99与17.08 mg/L,Z=-3.983,P＜0.001)、外周血WBC(7.843±3.025)×109/L与(6.333±3.569)×109/L,t=4.209,P＜0.001]、单核细胞(0.522±0.201)×109/L与(0.417±0.157)×109/L,t=5.084,P＜0.001]、血糖(6.518±2.303)与(5.691±2.085)mmol/L,t=3.461,P=0.001]、收缩压(134.7±27.8)与(142.0±26.3)mm Hg,t=2.536,P=0.012]等指标差异均有统计学意义.2组间吸烟比例43.7%(66/151)和23.1%(49/212),X2=17.283,P＜0.001]、男性比例74.8%(113/151)和48.6%(103/212),X2=25.217,P＜0.001]差异亦有统计学意义.经过多因素回归分析发现:年龄(X2=10.369,P=0.001)、性别(X2=12.836,P＜0.001)、BNP(X2=4.807,P=0.028)、WBC(X2=10.788,P=0.001)是造成2组间差异的主要原因.在ACS组,BNP与患者的左心室射血分数值之间存在线性关系(t=5.789,P＜0.001).结论 高龄、男性、外周血WBC和BNP与ACS存在密切关系,而BNP更对ACS患者的预后具有一定的预测价值.

Significance of B-type natriuretic peptide in acute coronary syndrome

Objective To investigate the significance of B-type natriuretic peptide (BNP) in acute coronary syndrome(ACS).Methods 151 in-patients of ACS during May 2006 to June 2008 were selected as the treatment group.Other 212 impatients with essential hypertension were selected as control group.Blood lipid,blood glucose,blood routine,renal function,high sensitive C-reaction protein (hs-CRP) and BNP were examined in all patients.Their blood pressure,heart rate,and history of smoking,hypertension,diabetes mellitus and hyperlipidemia 62.0±14.2,t = 5.043,P＜0.001 ),blood creatinine (95.0±67.4 ) vs.(72.8±29.0) μmol/L,t = 4.164,P ＜0.001 ),blood uric acid (360.2±104.4 ) vs.(300.8±92.7 ) μmol/L,t = 5.521,P ＜ 0.001 ],BNP (80.81 vs.352.38 ng/L,Z = - 7.295,P ＜ 0.001 ),hs-CRP (7.99 vs.17.08,Z = - 3.983,P ＜ 0.001 ),white blood cells (WBC) (7.843 +3.025)×109/L vs.(6.333±3.569)×109/L,t =4.209,P ＜0.001 ],monocytes (0.522±0.201)×109/L vs.(0.417±0.157)×109/L,t = 5.084,P ＜0.001 ] and blood glucose (6.518±2.303 ) vs.(5.691±2.085 ) mmol/L,t = 3.461,P = 0.001 ] had significant difference.Systolic blood pressure had difference between two groups (134.7±27.8 ) vs.(142.0±26.3 ) mm Hg,t = 2.536,P=0.012 ].However,the percentage of smoking 43.7% (66/151)vs.23.1% (49/212),X2 = 17.283,P ＜0.001 ] and male gender 74.8% ( 113/151 )vs.48.6% ( 103/212),X2 = 25.217,P ＜ 0.001 ) ] had significant difference between two groups ( P ＜0.001 ).Multivariable regression analysis showed that age (X2 = 10.369,P =0.001 ),gender (X2 = 12.836,P ＜ O.001 ),BNP (X2 =4.807,P =0.028) and WBC(X2= 10.788,P =0.001 ) were the main factors of difference between the two groups.Moreover,BNP was linearly correlated with left ventricular ejection fraction(EF) in ACS patients (t =5.789,P ＜ 0.001 ).Conclusion Old age,male,WBC and BNP are closely related with ACS,of which BNP has certain predictive value for ACS.