血浆BNP在急性心肌缺血损伤中的临床意义
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摘要
目的：探讨血浆B型钠尿肽(Brain natriuretic peptide, BNP,又称脑钠素),在急性心肌缺血损伤时的变化及对临床意义。
方法：本研究采用回顾性分析的方法,对2009年10月至2011年2月,16个月内吉林省人民医院心内科与急诊内科,收治的62例冠心病,急性心肌缺血损伤的患者进行研究。其中不稳定性心绞痛病例组34例,男性20例,女性14例。急性心肌梗死病例组28例,男性16例,女性12例。在不稳定性心绞痛病人急性发作时,抽取血液样本。急性心肌梗死患者入院即时,抽取血液样本,并间隔4-6小时再次抽取取血液心肌酶样本,随后动态监测心肌梗死患者心肌酶变化。所有患者均在治疗前抽取血液样本,经给予硝酸酯类扩冠、阿司匹林、氯吡格雷抗血小板、肝素抗凝、他汀类调脂、血管紧张素转换酶抑制剂、钙拮抗剂、β受体阻滞剂及介入等积极治疗,症状好转,血液动力学稳定后,再次采取血液样本进行测定,与前次样本进行比较。血浆BNP与肌钙蛋白Ⅰ的测定,采用微粒化学发光免疫测定发,使用美国BECKMAN Access2机器。BNP正常参考值为0-100 pg/ml。肌钙蛋白Ⅰ正常参考值为0-0.06 ng/ml。
结果：两组患者均于入院即时,或急性发病尚未给予治疗时,及经积极治疗后,抽取血液样本测定血浆BNP与肌钙蛋白Ⅰ,不稳定性心绞痛组发病时血浆BNP测定结果为264.7±11.5 pg/ml,经治疗后血浆BNP测定结果为104.6±14.1pg/ml,急性心肌梗死组治疗前血浆BNP测定结果为342.8±15.7 pg/ml,治疗后血浆BNP测定结果为132.5±12.7 pg/ml。各组肌钙蛋白Ⅰ的测定结果,治疗前均在正常范围内,治疗后不稳定性心绞痛组血浆肌钙蛋白Ⅰ无明显变化,而急性心肌梗死组血浆肌钙蛋白工测定结果呈动态演变。上述两组测定结果治疗前后相比,差异有统计学意义(P<0.05)。
结论：急性心肌缺血损伤是血浆BNP释放的重要因素。急性心肌缺血损伤患者治疗前与治疗后相比血浆BNP水平存在显著差异。血浆BNP检测,对急性心肌缺血损伤的早期诊断及治疗有重要意义及应用价值,并能在一定程度上反映心肌缺血损伤程度。
Objective:Study the clinical significance of plasma B-type natriuretic peptide (BNP) changes in acute myocardial ischemia injury
Methods:Retrospective analyse 62 CHD patients who are from the cardiology and emergency department in people hospital of Jilin province during February 2009 to October 2011,34 cases with unstable angina pain, Male 20, Female 14,28 patients with acute myocardial infarction, Male 16, Female 12. When unstable angina acute attack we take the blood samples. Admission in patients with acute myocardial infarction take the blood samples immediately.. Interval of 4-6 hours to take blood samples again, followed by dynamic monitoring of changes in myocardial enzymes in patients with myocardial infarction. All patients were given nitrates to expand coronary artery, aspirin and clopidogrel to resisto blood platelet, heparin anticoagulant, statins regulate lipid, angiotensin-converting enzyme inhibitors, calcium antagonists,β-blockers and other active interventive treatment, when the Symptoms release and hemodynamic stability, take the blood samples and measured again, compared results of the two samples. BNP and troponin I was measured by chemiluminescent immunoassay fat particles, Using U.S. BECKMAN Access2 machine. The normal reference value of BNP was 0-100 pg/ml. The normal reference value of troponin I wae 0-0.06 ng/ml.
Results:All patients in the hospital immediately, or the treatment of acute disease has not yet given, and after active treatment, take the plasma BNP and troponin I. The plasma BNP was264.7±11.5pg/ml in unstable angina pectoris patiens, then it reduced to104.6±14.1pg/ml after the treatment. In acute myocardial infarction patients the plasma BNP was 342.8±15.7pg/ml, then it reduced to 132.5±12.7pg/ml after the treatment. The troponin I were all in normal range in each group before the treatment, then presents the dynamic evolution after the treatment in acute myocardial infarction patiets. There was significant difference between before and after treatment (P<0.05).
Conclusion:Acute myocardial ischemia is an important factor in the release of plasma BNP. There was significant difference of BNP levels in acute myocardial ischemia patients before and after the treatment. Plasma BNP has an important value in early diagnosis and treatment of acute myocardial ischemia, and to some extent, it reflect the degree of myocardial ischemia.
方法：本研究采用回顾性分析的方法,对2009年10月至2011年2月,16个月内吉林省人民医院心内科与急诊内科,收治的62例冠心病,急性心肌缺血损伤的患者进行研究。其中不稳定性心绞痛病例组34例,男性20例,女性14例。急性心肌梗死病例组28例,男性16例,女性12例。在不稳定性心绞痛病人急性发作时,抽取血液样本。急性心肌梗死患者入院即时,抽取血液样本,并间隔4-6小时再次抽取取血液心肌酶样本,随后动态监测心肌梗死患者心肌酶变化。所有患者均在治疗前抽取血液样本,经给予硝酸酯类扩冠、阿司匹林、氯吡格雷抗血小板、肝素抗凝、他汀类调脂、血管紧张素转换酶抑制剂、钙拮抗剂、β受体阻滞剂及介入等积极治疗,症状好转,血液动力学稳定后,再次采取血液样本进行测定,与前次样本进行比较。血浆BNP与肌钙蛋白Ⅰ的测定,采用微粒化学发光免疫测定发,使用美国BECKMAN Access2机器。BNP正常参考值为0-100 pg/ml。肌钙蛋白Ⅰ正常参考值为0-0.06 ng/ml。
结果：两组患者均于入院即时,或急性发病尚未给予治疗时,及经积极治疗后,抽取血液样本测定血浆BNP与肌钙蛋白Ⅰ,不稳定性心绞痛组发病时血浆BNP测定结果为264.7±11.5 pg/ml,经治疗后血浆BNP测定结果为104.6±14.1pg/ml,急性心肌梗死组治疗前血浆BNP测定结果为342.8±15.7 pg/ml,治疗后血浆BNP测定结果为132.5±12.7 pg/ml。各组肌钙蛋白Ⅰ的测定结果,治疗前均在正常范围内,治疗后不稳定性心绞痛组血浆肌钙蛋白Ⅰ无明显变化,而急性心肌梗死组血浆肌钙蛋白工测定结果呈动态演变。上述两组测定结果治疗前后相比,差异有统计学意义(P<0.05)。
结论：急性心肌缺血损伤是血浆BNP释放的重要因素。急性心肌缺血损伤患者治疗前与治疗后相比血浆BNP水平存在显著差异。血浆BNP检测,对急性心肌缺血损伤的早期诊断及治疗有重要意义及应用价值,并能在一定程度上反映心肌缺血损伤程度。
Objective:Study the clinical significance of plasma B-type natriuretic peptide (BNP) changes in acute myocardial ischemia injury
Methods:Retrospective analyse 62 CHD patients who are from the cardiology and emergency department in people hospital of Jilin province during February 2009 to October 2011,34 cases with unstable angina pain, Male 20, Female 14,28 patients with acute myocardial infarction, Male 16, Female 12. When unstable angina acute attack we take the blood samples. Admission in patients with acute myocardial infarction take the blood samples immediately.. Interval of 4-6 hours to take blood samples again, followed by dynamic monitoring of changes in myocardial enzymes in patients with myocardial infarction. All patients were given nitrates to expand coronary artery, aspirin and clopidogrel to resisto blood platelet, heparin anticoagulant, statins regulate lipid, angiotensin-converting enzyme inhibitors, calcium antagonists,β-blockers and other active interventive treatment, when the Symptoms release and hemodynamic stability, take the blood samples and measured again, compared results of the two samples. BNP and troponin I was measured by chemiluminescent immunoassay fat particles, Using U.S. BECKMAN Access2 machine. The normal reference value of BNP was 0-100 pg/ml. The normal reference value of troponin I wae 0-0.06 ng/ml.
Results:All patients in the hospital immediately, or the treatment of acute disease has not yet given, and after active treatment, take the plasma BNP and troponin I. The plasma BNP was264.7±11.5pg/ml in unstable angina pectoris patiens, then it reduced to104.6±14.1pg/ml after the treatment. In acute myocardial infarction patients the plasma BNP was 342.8±15.7pg/ml, then it reduced to 132.5±12.7pg/ml after the treatment. The troponin I were all in normal range in each group before the treatment, then presents the dynamic evolution after the treatment in acute myocardial infarction patiets. There was significant difference between before and after treatment (P<0.05).
Conclusion:Acute myocardial ischemia is an important factor in the release of plasma BNP. There was significant difference of BNP levels in acute myocardial ischemia patients before and after the treatment. Plasma BNP has an important value in early diagnosis and treatment of acute myocardial ischemia, and to some extent, it reflect the degree of myocardial ischemia.
引文
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