Kuklinska Agnieszka M, Sobkowicz Bozena, Mroczko Barbara, Sawicki Robert, Musial Wlodzimierz J, Knapp Malgorzata, Dobrzycki Slawomir, Szmitkowski Maciej
Department of Cardiology, Medical University, Bialystok, Poland ul Sklodowskiej-Curie 24a, Bialystok, Poland.
Clin Chim Acta. 2007 Jul;382(1-2):106-11. doi: 10.1016/j.cca.2007.04.002. Epub 2007 Apr 12.
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).
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.
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).
Admission plasma BNP concentrations provide incremental prognostic information in patients with first STEMI treated with pPCI.
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。
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）。
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）。
入院时血浆BNP浓度为接受pPCI治疗的首次STEMI患者提供了额外的预后信息。
