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目的:目前急性冠脉综合征中ST段抬高心肌梗死患者B型脑钠肽水平增高及意义已得到广泛的认同,但对于非ST段抬高心肌梗死(Non-ST elevation myocardial infarction,NSTEMI)和不稳定性心绞痛(Unstable angina,UA)患者B型脑钠肽的变化及差别尚不肯定。本文通过分析其规律及与近期心血管事件的关系,用于危险分层评估。方法:入选急性冠脉综合征患者138例,其中NSTEMI组69例,UA组69例,同时入选胸痛就诊但冠状动脉造影正常的患者30例作为对照组。所有患者于发病6小时从周围静脉中留取血样测定B型脑钠肽,同期测定全血肌钙蛋白I。随访3个月内主要不良心血管事件的发生率。结果:①NSTEMI组、UA组、对照组B型脑钠肽水平分别为34.9pg/ml(四分位区间为18.20pg/ml至81.85pg/ml)、13.9pg/ml(四分位区间为8.00pg/ml至26.45pg/ml)和9.4pg/ml(四分位区间为5.00pg/ml至12.6pg/ml),3组之间比较差异有统计学意义,P<0.05。NSTEMI组B型脑钠肽水平最高,并且与全血肌钙蛋白I水平呈正相关(r=0.675,P<0.001)。②随访3个月,138例中有30例患者(21.7%)发生主要不良心血管事件,发生者B型脑钠肽水平高于未发生者(31.3pg/ml vs 19.35pg/ml),P=0.001。结论:非ST段抬高急性冠脉综合征患者早期B型脑钠肽水平明显升高,并且B型脑钠肽水平与近期心血管事件的发生有一定相关性,可应用于危险分层的评估。
OBJECTIVE: At present, the level of B-type natriuretic peptide is elevated in patients with ST-elevation myocardial infarction in acute coronary syndrome and its significance has been widely recognized. However, for non-ST elevation myocardial infarction (NSTEMI) And unstable angina (Unstable angina, UA) patients with brain natriuretic peptide changes and the difference is still not sure. This article uses risk stratification assessment by analyzing its pattern and its relationship to recent cardiovascular events. Methods: A total of 138 patients with acute coronary syndrome were enrolled. Among them, 69 patients in NSTEMI group and 69 patients in UA group were enrolled. Thirty patients with chest pain and normal coronary angiography were selected as control group. All patients in the incidence of 6 hours from the peripheral venous blood samples were taken to determine B-type brain natriuretic peptide, simultaneous measurement of whole blood troponin I. The incidence of major adverse cardiovascular events within 3 months of follow-up. Results: ① The levels of brain natriuretic peptide of type B in NSTEMI group, UA group and control group were 34.9pg / ml (interquartile range from 18.20pg / ml to 81.85pg / ml) and 13.9pg / ml (interquartile range was 8.00 pg / ml to 26.45 pg / ml) and 9.4 pg / ml (quartiles ranged from 5.00 pg / ml to 12.6 pg / ml). The difference between the three groups was statistically significant, P <0.05. NSTEMI group had the highest level of B-type natriuretic peptide, and positively correlated with the level of whole blood troponin I (r = 0.675, P <0.001). During the follow-up period of 3 months, major adverse cardiovascular events occurred in 30 of 138 patients (21.7%), with higher levels of B-type natriuretic peptide than those without (31.3pg / ml vs 19.35pg / ml), P = 0.001. Conclusion: The levels of early brain natriuretic peptide are significantly increased in patients with non-ST-segment elevation acute coronary syndrome and the level of brain natriuretic peptide is associated with recent cardiovascular events and may be used in risk stratification Evaluation.