急性心肌梗死患者血糖、糖化血清蛋白和N末端B型钠尿肽原的临床检测价值

摘要

目的 通过观察急性心肌梗死(AMI)患者血糖(Glu)、糖化血清蛋白(GSP)、B型钠尿肽原(NT-proBNP)水平变化及并发症发生状况,探讨联合检测的临床价值.方法 据AMI患者入院时有无合并糖尿病分为已知糖尿病组、未知糖尿病组及无糖尿病组,于入院时采集患者外周血,检测血清Glu(葡萄糖氧化酶法)、GSP(果糖胺法)及NT-proBNP(电化学发光免疫分析法)水平,并观察患者住院期间并发症的发生情况.结果 AMI各组患者入院时,已知糖尿病组血清Glu、GSP和NT-proBNP水平[(9.16±0.97) mmol/L、(2.14±0.47) mmol/L和(531.1±99.0) pg/ml]显著高于正常对照组[(5.08±0.91) mmol/L、(1.98±0.41) mmol/L和(47.7±11.6) pg/ml] (P＜0.05);未知糖尿病组血清Glu、GSP和NT-proBNP水平[(13.73±1.39) mmol/L、(3.49±0.62) mmol/L和(966.3±120.7 pg/ml)]显著高于正常对照组(P＜0.05);无糖尿病组血清Glu和NT-proBNP水平[(8.62±0.85) mmol/L和(319.2±87.4) pg/ml]显著高于正常对照组(P＜0.05),但血清GSP水平[(2.06±0.43) mmol/L]差异无统计学意义(P＞0.05);未知糖尿病组与已知糖尿病组及无糖尿病组比较,血清Glu、GSP和NT-proBNP水平差异均具有统计学意义(P＜0.05).住院期间,已知糖尿病组及未知糖尿病组心血管事件发生率(46.7％、64.1％)均显著高于无糖尿病组(28.0％)(x2=3.847、11.600,P＜0.05),未知糖尿病组与已知糖尿病组差异无统计学意义(x2=2.564,P＞ 0.05).结论 血清GSP可作为区分AMI患者Glu增高属于应激性还是糖尿病性的重要依据,血清NT-proBNP可判断AMI患者心功能损害程度.联合检测血清Glu、GSP及NT-proBNP水平,可作为指导AMI患者的临床治疗及预测预后的指标.%Objective To explore the clinical value of combination examination obvesing the changes of the levels of Glu,GSP,and NT-proBNP and the occurrence status of complications in patients with acute myocardial infarction (AMI).Methods According to the patients with AMI whether complicated with diabetes or not,they were divided into a diabetes group,an unknown diabetes group,and a no diabetes group.When admitted into our hospital,the peripheral blood of the patients were collected to detect the serum levels of Glu(glucose oxidase method),GSP(fructosamine method),and NT-proBNP (electrochemical luminescence immunoassay).During hospitalization,complications of the patients were observed.Results When admitted into our hospital,the serum levels of Glu,GSP,and NT-proBNP were significantly higher in the diabetes group than in the normal control group [(9.16±0.97) mmol/L,(2.14±0.47) mmol/L,and (531.1±99.0) pg/ml vs.(5.08±0.91) mmol/L,(1.98±0.41) mmol/L,and (47.7±11.6) pg/ml] (P＜0.05).The serum levels of Glu,GSP,and NT-proBNP of the unknown diabetes group [(13.73±1.39) mmol/L,(3.49±0.62) mmol/L,and (966.3±120.7) pg/ml] were significantly higher than those of the normal control group (P＜0.05).The serum levels of Glu and NT-proBNP of the no diabetes group [(8.62±0.85) mmol/L and (319.2±87.4) pg/ml] were significantly higher than those of the normal control group (P＜0.05),but there was no statistical difference in the serum level of GSP [(2.06±0.43) mmol/L in the no diabetes group] between these two groups (P＞0.05).There were no statistical differences in the serum levels of Glu,GSP,and NT-proBNP between the diabetes group and unknown diabetes group (P＜0.05).During hospitalization,the incidences of cardioascular events of the diabetes group and the unknown diabetes group (46.7％ and 64.1％) were significantly higher than that of the no diabetes group (28.0％) (x 2=3.847,11.600,P＜0.05),but there was no statistical difference between the diabetes group and the unknown diabetes group (x 2=2.564,P＞0.05).Conclusions The serum level of GSP can be used to the distinguish the increase of the serum level of Glu in patients with AMI whether is cause by irritability or diabetics.The serum level of NT-proBNP can be used to judge the degree of cardiac damage in patients with AMI.Combined detection of serum levels of Glu,GSP,and NT-proBNP can guide the clinical treatment and prognosis prediction of patients with AMI.