血浆脑钠肽在判断急性心肌梗死血管病变及预后中的价值

摘要目的通过研究急性ST抬高型心肌梗死（acute ST elevation myocardial infarction，STEMI）者血浆脑钠肽（brain natri-uretic peptide，BNP）水平与血管病变及近期预后的关系来探讨其临床价值。方法选择STEMI者126例，据入院BNP水平由低到高由4个百分位数分为4组：A组（BNP≤105ng／L）、B组（BNP105．1-339．Ong／L）、c组（BNP339．1-1188．0ng／L）和D组（BNP〉1188ng／L）。90min内进行冠状动脉造影（coronary angiography，CAG）和经皮冠状动脉介入术（percutaneous coronary inter-vention，PCI），测定Gensini积分，记录1个月内并发症。结果①与A组、B组比较，D组多支冠脉病变比例显著增高（P〈0．01），与c组比较，D组多支冠脉病变比例有增高趋势（P〉0．05）；②与前一组比较各组Gensini积分显著增高（P〈0．01）；③血浆BNP水平与Gensini积分呈正相关（r=0．673，P〈0．01）；④与A组、B组比较，D组心血管事件发生率显著增高（P〈0．01）；与c组比较，D组心血管事件发生率有增高趋势（P〉0．05）。结论①STEM]者血浆BNP水平可能与冠状动脉病变支数及程度呈正相关；②AMI早期血浆BNP水平显著升高提示心血管事件发生率高，可作为心血管事件的预测因子。

Value of Plasma Brain Natriuretic Peptide in Judging Vascular Lesions and Prognosis of Acute Myocardial Infarction.

Objective To explore the clinical value of plasma brain natriuretic peptide（BNP）by studying the relationship of it and coronary artery lesions and short - term prognosis in acute ST - segment elevation myocardial infarction （STEMI） patients. Methods Based on BNP concentration, 126 patients with STEMI were divided into four groups：A group （BNP ≤ 107ng/L） , B group（ BNP109.1 - 339.0ng/L） ,C group（ BNP339.1 - 1188.0ng/L） and D group（ BNP 〉 1188ng/L）. Coronary angiography and percutaneous coronary in- tervention were corried out in 90 minutes. Vessle lesions and Gensini score were determined according to CAG and cardiac events were ob- served in each patient within 1 month after AMI. Results ①The proportion of muhiful branches artery diease in D group increased signifi- cantly compared with A and B groups respectivly（ P 〈 0.01 ）. The proportion of multiful branches artery diease in D group has the trend of increasing compared with the C group （ P 〉 0.05 ）. ②The Gensini score in latter group increased significantly compared with previous group （P 〈 0.01 ）. ③Plasma BNP level has positive correlation with the Gensini score（ r = 0. 673 ,P 〈 0.01 ）. ④The incidence of cardiovascular events in D group increased significantly comoared with A and B grouos resDectivelv（ P 〈 0.01 ）. The incidence of cardiovascular events inD group has the trend of increasing compared with C group（P 〉 0.05）. Conclusion The increased degree of serum BNP may have posi- tive correlation with the number of diseased coronary artery and the severity of coronary diease in patients with STEMI. The serum BNP density increasing sharply suggestes that the incidence of cardiovascular events is high,BNP can be used as the predictive factor of cardio- vascular events after AMI.