Panteghini Mauro, Cuccia Claudio, Bonetti Graziella, Pagani Franca, Giubbini Raffaele, Bonini Elena
Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera "Spedali Civili", Brescia, Italy.
Clin Chem Lab Med. 2003 Feb;41(2):164-8. doi: 10.1515/CCLM.2003.027.
We evaluated a rapid brain natriuretic peptide (BNP) assay (Triage BNP, Biosite Diagnostics) as indicator of infarct size, left ventricular (LV) dysfunction, and longterm survival in patients with acute myocardial infarction (AMI) during the coronary care unit stay. We studied 64 AMI patients in whom infarct size was estimated by creatine kinase isoenzyme MB (CK-MB) peak concentrations and single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi, and LV function by gated SPECT imaging. Measurements of BNP and SPECT were performed approximately 3 days after admission. SPECT was also repeated 3 months later. We found a significant correlation between BNP and both the peak CK-MB concentrations (r = 0.40, p = 0.001) and the perfusion defect size at SPECT (r = 0.38, p = 0.002). BNP was weakly related to LV ejection fraction (LVEF) assessed both early and 3 months after AMI (r = -0.29, p = 0.02; and r = -0.27, p = 0.04, respectively). The sensitivity and specificity of BNP for predicting survival of patients over 1 year of follow-up was 100% and 43%, respectively, with a negative predictive value of 100%. The positive predictive power of BNP was very modest (12%). Considering our results, the measurement of BNP did not look nearly as promising when tested in the setting of our cardiological intensive care.
我们评估了一种快速脑钠肽（BNP）检测方法（Triage BNP，Biosite Diagnostics公司），将其作为急性心肌梗死（AMI）患者在冠心病监护病房住院期间梗死面积、左心室（LV）功能障碍及长期生存情况的指标。我们研究了64例AMI患者，通过肌酸激酶同工酶MB（CK-MB）峰值浓度及使用锝-99m甲氧基异丁基异腈的单光子发射计算机断层扫描（SPECT）心肌灌注来估算梗死面积，通过门控SPECT成像评估LV功能。入院后约3天进行BNP和SPECT检测。3个月后也重复进行SPECT检测。我们发现BNP与CK-MB峰值浓度（r = 0.40，p = 0.001）及SPECT灌注缺损面积（r = 0.38，p = 0.002）均显著相关。BNP与AMI早期及3个月后评估的左心室射血分数（LVEF）呈弱相关（分别为r = -0.29，p = 0.02；r = -0.27，p = 0.04）。BNP预测患者1年以上随访生存情况的敏感性和特异性分别为100%和43%，阴性预测值为100%。BNP的阳性预测能力非常有限（12%）。考虑到我们的研究结果，在我们的心脏重症监护环境中进行检测时，BNP检测的前景似乎并不乐观。
