Yamamoto Takeshi, Sato Naoki, Yasutake Masahiro, Takagi Hiromichi, Morita Norishige, Akutsu Koichi, Fujii Masahiro, Fujita Nobuhiko, Tanaka Keiji, Takano Teruo
Intensive and Coronary Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Int J Cardiol. 2006 Aug 10;111(2):224-30. doi: 10.1016/j.ijcard.2005.07.010. Epub 2005 Sep 26.
Elevated B-type natriuretic peptide (BNP) levels show prognostic significance in patients with non-ST elevation acute coronary syndromes, but the underlying pathophysiology remains unclear.
Two hundred and eighteen consecutive patients with non-ST elevation acute coronary syndromes were studied retrospectively. We compared clinical characteristics between groups with plasma BNP levels above or below the median value, and performed multiple logistic regression analysis to identify independent predictors of supramedian BNP levels.
Patients with supramedian BNP (>or=134 pg/ml) were more likely to be elderly (>or=75 years) with diabetes, prior myocardial infarction, and a history of coronary artery bypass grafting. They also had higher cardiac marker levels, a higher Killip class, a lower left ventricular ejection fraction, renal insufficiency (creatinine>or=1.5 mg/dl), and more 3-vessel disease. In multivariate analysis, the strongest independent predictor of supramedian BNP levels was 3-vessel disease (chi(2)=12.1), followed by old age (chi(2)=10.3), renal insufficiency (chi(2)=5.0), higher Killip class (chi(2)=4.2), and lower left ventricular ejection fraction (chi(2)=4.1). All 11 patients dying in hospital had supramedian BNP levels. Its elevation reflected the risk of 3-vessel disease and coronary artery bypass grafting regardless of troponin status.
In unselected patients with non-ST elevation acute coronary syndromes, an increase of BNP is correlated with the extent of myocardial ischemia, age, renal insufficiency, and ventricular dysfunction. It may be a useful biomarker integrating conventional risk factors for risk stratification in this population.
B型利钠肽（BNP）水平升高在非ST段抬高型急性冠状动脉综合征患者中具有预后意义，但其潜在病理生理学仍不清楚。
对218例连续的非ST段抬高型急性冠状动脉综合征患者进行回顾性研究。我们比较了血浆BNP水平高于或低于中位数的两组患者的临床特征，并进行多因素逻辑回归分析以确定BNP水平高于中位数的独立预测因素。
BNP水平高于中位数（≥134 pg/ml）的患者更可能为老年（≥75岁），患有糖尿病、既往心肌梗死和冠状动脉旁路移植术史。他们还具有更高的心脏标志物水平、更高的Killip分级、更低的左心室射血分数、肾功能不全（肌酐≥1.5 mg/dl）以及更多的三支血管病变。在多变量分析中，BNP水平高于中位数的最强独立预测因素是三支血管病变（χ²=12.1），其次是老年（χ²=10.3）、肾功能不全（χ²=5.0）、更高的Killip分级（χ²=4.2）和更低的左心室射血分数（χ²=4.1）。所有11例住院死亡患者的BNP水平均高于中位数。其升高反映了三支血管病变和冠状动脉旁路移植术的风险，与肌钙蛋白状态无关。
在未经选择的非ST段抬高型急性冠状动脉综合征患者中，BNP升高与心肌缺血程度、年龄、肾功能不全和心室功能障碍相关。它可能是一种有用的生物标志物，可整合传统危险因素用于该人群的危险分层。
