床边BNP测定对非ST段抬高急性冠脉综合症意义.docVIP

床边BNP测定对非ST段抬高急性冠脉综合症意义【摘要】 目的：探讨床边测定脑钠素（BNP）水平评估非ST段抬高（NSTE Non-ST elevation）的急性冠脉综合症（ACS acute coronary syndrome）患者心肌缺血程度的临床应用价值。方法 116名NSTE ACS患者(其中不稳定型心绞痛患者77名，非ST段抬高心梗患者39名)和23名作为对照组的稳定型心绞痛患者，用床边定量心脏标志物检测仪快速测定血浆BNP水平，通过冠状动脉造影gensini积分判断患者的心肌缺血程度，分析BNP和gensini积分的关系，并比较83名经PTCA及冠状动脉内支架植入术的ACS患者术前和术后的BNP变化。结果 与稳定型心绞痛患者比较，不稳定心绞痛患者和NSTEMI患者的BNP 水平明显升高（72.8±52.3 VS.19.5±14.9, p＜0.05；197.4±154.5 VS.19.5±14.9, p＜0.01）， NSTEACS患者的BNP 水平与Gensini 积分密切相关（r=0.772，p＜0.05），83名行PTCA及冠状动脉内支架植入术的ACS患者术后BNP水平较术前明显降低(40.3±37.8 VS.207.5±185.6, p＜0.05)。结论 血浆BNP水平可以作为评价NSTE患者心肌缺血程度的临床指标。 关键词：脑钠素 心肌缺血急性冠脉综合症 The value of bedside determinations of brain natriuretic peptid for diagnosis of Non-ST elevation Non-ST elevation acute coronary syndrome. 【Abstract】Objective To evaluate bedside determination of brain natriuretic peptide(BNP) in assessing the extent of myocardial ischemia in patients with non-ST elevation acute conorary syndrome(ACS). Methods Rapid bedside test for BNP was measured in 116 patients with non-ST ACS( 77 patients with unstable angina and 39 patients with non-ST elevation myocardial infarction) and 23 patients with stable angina enrolled as the positive control group. Additionally, in 83 ACS patients having undergone PCI the BNP level was measured a week later. The extent of myocardial ischemia was estimated by the conorary angiographic Gensini score. Results The BNP levels were increased in patients with unstable angina and non-ST elevation myocardial infarction compared with stable angina patients (72.8±52.3 VS.19.5±14.9, p＜0.05；197.4±154.5 VS.19.5±14.9, p＜0.01).The BNP levels were found to correlate with the Gensini score in NSTEACS(r=0.772，p＜0.05). In 83 ACS patients having undergone PCI ,the postoperative BNP levels were significantly lower than the preoperative levels(40.3±37.8 VS.207.5±185.6, p＜0.05). Conclusions The BNP level might be a useful marker in the assessment of the extent of myocardial ischemia in patients with NSTEACS. Key words: brain