首次ST段抬高型心肌梗死患者入院时血浆B型利钠肽测定与C反应蛋白及TIMI风险评分相比的预后意义

Prognostic significance of the admission plasma B-type natriuretic peptide measurement in patients with first ST-elevation myocardial infarction in comparison with C-reactive protein and TIMI risk score.

作者信息

Kuklinska Agnieszka M, Sobkowicz Bozena, Mroczko Barbara, Sawicki Robert, Musial Wlodzimierz J, Knapp Malgorzata, Dobrzycki Slawomir, Szmitkowski Maciej

机构信息

Department of Cardiology, Medical University, Bialystok, Poland ul Sklodowskiej-Curie 24a, Bialystok, Poland.

出版信息

Clin Chim Acta. 2007 Jul;382(1-2):106-11. doi: 10.1016/j.cca.2007.04.002. Epub 2007 Apr 12.

DOI:10.1016/j.cca.2007.04.002

PMID:17482153

Abstract

BACKGROUND

In ST-elevation myocardial infarction (STEMI) B-type natriuretic peptide (BNP) holds promise for risk stratification. Aim of this study was to assess prognostic value of plasma BNP measurement and to compare with other powerful prognostic markers -- TIMI Risk Score (TRS) and C-reactive protein (CRP) in patients with first STEMI treated with primary PCI (pPCI).

METHODS

86 patients, admitted within initial 12 h of the first STEMI. Admission plasma levels of BNP were measured by MEIA method. Serum levels of CRP were measured using immunoturbidimetric assays. Composite end point (CEP) was assessed after 7 months.

RESULTS

Median plasma BNP value was higher in patients with CEP, compared with those without CEP (p<0.001). Patients with plasma BNP >99.2 pg/mL were at significantly higher risk for CEP (the highest sensitivity and specificity). CRP level >10.6 mg/dL was also associated with poor outcome. TRS has not influenced the occurrence of CEP. In the analysis of logistic regression the BNP value >99.2 pg/mL was the strongest predictor of CEP. ROC analysis identified BNP measurement as significant to estimate adverse outcome 0.950 in the prediction of CEP (95% Confidence interval=0.878-0.985).

CONCLUSION

Admission plasma BNP concentrations provide incremental prognostic information in patients with first STEMI treated with pPCI.

摘要

背景

在ST段抬高型心肌梗死（STEMI）中，B型利钠肽（BNP）有望用于危险分层。本研究的目的是评估血浆BNP检测的预后价值，并与其他强大的预后标志物——TIMI风险评分（TRS）和C反应蛋白（CRP）在接受直接经皮冠状动脉介入治疗（pPCI）的首次STEMI患者中进行比较。

方法

86例患者在首次STEMI发病最初12小时内入院。采用微粒子酶免疫分析法（MEIA法）测定入院时血浆BNP水平。采用免疫比浊法测定血清CRP水平。7个月后评估复合终点（CEP）。

结果

与无CEP的患者相比，有CEP的患者血浆BNP中位数更高（p<0.001）。血浆BNP>99.2 pg/mL的患者发生CEP的风险显著更高（敏感性和特异性最高）。CRP水平>10.6 mg/dL也与不良预后相关。TRS未影响CEP的发生。在逻辑回归分析中，BNP值>99.2 pg/mL是CEP最强的预测因子。ROC分析确定BNP检测对估计CEP不良结局具有显著意义，预测值为0.950（95%置信区间=0.878-0.985）。