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目的:观察血氨基末端脑钠素前体(NT-proBNP)对急性冠状动脉综合征(ACS)患者的远期预测价值。方法:将85例发病24h以内的ACS患者,分为ST段抬高的急性心肌梗死、非ST段抬高的急性心肌梗死和不稳定型心绞痛3组。所有病例既往均无明显心功能不全。于入院即刻、24h及1周测NT-proBNP,高敏C反应蛋白(hs-CRP),7～10d查超声心动图,记录随访1年的病死率和心血管事件住院率。结果:所有ACS患者的NT-proBNP峰值均高于正常,高峰见于入院24h。随访中病死率、所有心血管事件住院率和心力衰竭住院率分别为5.9%、17.6%、和10.6%。多因素回归分析显示hs-CRP峰值、肌酸激酶-同工酶、恶性心律失常、左室射血分数及NT-proBNP峰值是远期心血管死亡的主要危险因子,而后两者又是心力衰竭事件的预测因子。结论:NT-proBNP峰值是ACS的独立危险因子,它对ACS的远期预测价值可能要优于hs-CRP。
Objective: To investigate the long-term predictive value of NT-proBNP in patients with acute coronary syndrome (ACS). Methods: Eighty-five patients with ACS within 24 hours of onset were divided into 3 groups: ST-elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction and unstable angina pectoris. All cases in the past no obvious cardiac dysfunction. NT-proBNP, high-sensitivity C-reactive protein (hs-CRP) and echocardiography were recorded at 7 to 10 days immediately after admission, and the 1-year follow-up mortality and cardiovascular hospitalization rate were recorded. Results: The peak NT-proBNP in all ACS patients was higher than normal, and the peak appeared at admission 24h. Mortality at follow-up, hospitalizations for all cardiovascular events and hospitalizations for heart failure were 5.9%, 17.6%, and 10.6%, respectively. Multivariate regression analysis showed that the hs-CRP peak, creatine kinase-isoenzyme, malignant arrhythmia, left ventricular ejection fraction and NT-proBNP peak were the major risk factors for long-term cardiovascular death, and the latter two were heart failure Predictors of events. Conclusion: The peak of NT-proBNP is an independent risk factor for ACS. Its long-term predictive value for ACS may be superior to hs-CRP.