B型钠尿肽在急性冠脉综合征患者早期诊断中的应用

目的：分析急性冠脉综合征（ACS）患者早期B型钠尿肽（BNP）水平的差异，评估BNP在早期诊断中的作用。方法：入选末次症状发作至就诊时间均〈6h的ACS患者221例．分为ST段抬高心肌梗死（STEMI）组（n=83）、非ST段抬高心肌梗死（NSTEMI）组（n=69）和不稳定性心绞痛（UA）组（n=69）。所有患者在入院即刻测定BNP水平，发病12h内测定肌钙蛋白Ⅰ（TnⅠ）。比较不同组间BNP的差别及BNP与TnⅠ的相关性。结果：UA、NSTEMI和STEMI患者基础血浆BNP浓度依次升高（分别为13．9pg／ml、34．9pg／ml和64．2pg／ml）（组间比较P〈0．01），且STEMI和NSTEMI患者BNP水平与TnⅠ正相关（叫分别为0．724和0．675，P均〈0．01）。BNP≥100pg／ml对NSTEMI诊断阳性预测值达83．3％。结论：ACS患者早期BNP水平升高．对早期鉴别NSTEMI和UA有一定价值．

Use of plasma B-type natriuretic peptide levels in evaluation of patients with acute coronary syndrome

Objective：To evaluate the diagnostic value of B-type natriuretic peptide （BNP）in patients with acute coronary syndrome （ACS）.Methods：Two hundred and twenty one patients with ACS were recruited whose latest onset time was within 6 hours.In them 83 patients had ST elevation myocardial infaretion（STEMI）,69 patients had non-ST elevation myocardial infaretion（NSTEMI）and 69 patients had unstable angina（UA）.Blood samples for BNP were drawn at admission.Results：A significant increase in BNP levels was observed in STEMI （64.2pg/ml） compared with the other groups. NSTEMI had higher BNP levels than UA（34.9pg/ml vs 13.9pg/ml, P〈0.01）. There was a significant correlation between BNP and troponin Ⅰ（TnⅠ） level in patients of STEMI and NSTEMI （γ=0.724 and 0.675, P〈0.01）.The positive predictive value of BNP≥ 100pg/ml in NSTEMI was 83.3%. Conclusion：BNP levels were increased significantly in patients with ACS and may be a useful adjunctive marker to diagnosis in patients suspected with ACS.