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目的:探讨急性冠状动脉综合征患者支架置入术前、后N-端脑钠素前体(N-terminal pro-brain natriureticpeptide,NT-proBNP)水平的变化及临床意义。方法:急诊行冠状动脉支架置入术的急性冠状动脉综合征患者99例,其中急性心肌梗死组56例,不稳定性心绞痛组43例。检测患者术前、术后即刻及术后7 d NT-proBNP水平,观察对术后3个月主要不良心血管事件的影响。结果:急性心肌梗死组与不稳定性心绞痛组NT-proBNP水平术前分别为(776.8±219.2)pg/mL与(351.2±123.4)pg/mL(P<0.01),术后即刻分别为(963.6±315.3)pg/mL与(372.5±142.1)pg/mL(P<0.01),术后7 d分别为(443.7±188.5)pg/mL与(275.6±98.2)pg/mL(P<0.01);术后即刻NT-proBNP水平均高于术前,但仅急性心肌梗死组与术前比较差异有统计学意义(P<0.05),术后7 d NT-proBNP水平较术前及术后即刻均降低(P<0.05),且急性心肌梗死组较不稳定性心绞痛组下降趋势更明显。基线NT-proBNP≥300 pg/mL患者术后3个月发生主要不良心血管事件率10.6%(7/66)高于NT-proBNP<300 pg/mL患者的6.1%(2/33)(P<0.05)。结论:急性冠状动脉综合征患者支架置入术前、后NT-proBNP水平存在动态改变,并与疾病严重程度及预后相关。
Objective: To investigate the changes and clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndrome before and after stent implantation. Methods: A total of 99 patients with acute coronary syndrome undergoing coronary stent implantation were enrolled. Among them, 56 were acute myocardial infarction and 43 were unstable angina. The level of NT-proBNP was measured before operation, immediately after operation and 7 days after operation. The main adverse cardiovascular events were observed at 3 months after operation. Results: The levels of NT-proBNP in acute myocardial infarction group and unstable angina group were (776.8 ± 219.2) pg / mL and (351.2 ± 123.4) pg / mL, respectively (443.7 ± 188.5) pg / mL and (275.6 ± 98.2) pg / mL (P <0.01) on the 7th day after operation, respectively. The level of NT-proBNP immediately after surgery was higher than that before operation, but the difference was statistically significant only in acute myocardial infarction group (P <0.05). The level of NT-proBNP in 7 days after operation was significantly higher than that before operation and immediately after operation (P <0.05), and the decreasing trend of acute myocardial infarction group was more obvious than that of unstable angina pectoris group. The rate of major adverse cardiovascular events at baseline 3 months after NT-proBNP ≥ 300 pg / mL was 10.6% (7/66) compared with 6.1% (2/33) for patients with NT-proBNP <300 pg / mL <0.05). Conclusion: The levels of NT-proBNP in patients with acute coronary syndrome before and after stenting are dynamic and correlated with the severity of the disease and prognosis.