NT-proBNP、心肌酶及炎性细胞因子检测对急性冠状动脉综合征患者的临床意义

摘要

目的:探讨氨基末端脑钠肽前体(NT-proBNP)、心肌酶学及血清炎性细胞因子在急性冠状动脉综合征(ACS)患者中的临床意义.方法:选取我院行冠状动脉造影响(CAG)确诊的ACS患者120例为研究对象,根据病变程度分为不稳定型心绞痛(UAP组)28例,急性非ST段抬高心肌梗死(NSTEMI组)41例,急性ST段抬高心肌梗死(STEMI组)51例,另选取同期行CAG阴性患者40例为对照组,采用标准Judkins法行冠状动脉造影(CAG)检查,多体位投照确定冠脉病变程度,于入院时采集外周静脉血,分离血清,采用荧光免疫吸附法测定NT-proBNP、肌酸激酶同工酶(CK-MB)水平;化学发光法测定心肌肌钙蛋白Ⅰ(cTnI)水平;免疫比浊法测定超敏C反应蛋白(hs-CRP)水平;酶联免疫法测定白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)水平.结果:对照组、UAP组、NSTEMI组、STEMI组血清NT-proBNP、CK-MB、cTnI、hs-CRP、IL-18、TNF-α和MMP-9水平呈依次增高趋势,各组间比较差异均有统计学意义(P<0.01).结论:血清NT-proBNP、CK-MB、cTnI、hs-CRP、IL-18、TNF-α、MMP-9联合检测对ACS的诊断、严重程度评估、危险分层、治疗方案制定等有重要意义.%Objective: To explore the clinical significance of NT-proBNP, myocardial enzymes, and inflammatory cytokines in diagnosis of acute coronary syndrome (ACS). Methods: A total of 120 patients with ACS confirmed by CAG who were admitted in our hospital from December, 2014 to December, 2016 were included in the study and divided into UAP group (n=28), NSTEMI group (n=41), and STEMI group (n=51) according to different lesion degrees. Moreover, 40 cases with negative CAG results were served as the control group. The standard Judkins method was used for CAG examination. Multi-position projection was performed to confirm the coronary lesion degrees. The peripheral venous blood was collected on admission, and the serum was separated. The fluorescence immunoassay was used to detect NT-proBNP and CK-MB levels. The chemiluminiscence was used to detect cTnI level. The immunoturbidimetry was used to detect hs-CRP level. ELISA was used to detect IL-18, TNF-α, and MMP-9 levels. Results: The serum NT-proBNP, CK-MB, cTnI, hs-CRP, IL-18, TNF-α, and MMP-9 levels were graudally increased in the control group, UAP group, NSTEMI group, and STEMI group, and the comparison among each group was statistically significant (P<0.01). Conclusions: The combined detection of serum NT-proBNP, CK-MB, cTnI, hs-CRP, IL-18, TNF-α, and MMP-9 is of great significance in diagnosis of ACS, evaluation of severity degree, risk stratification, and formulation of therapeutic schemes.