CAJ | 학술논문

目的通过持续12-导联ECG ST段监测,评估血液中B型尿钠肽(BNP)、高敏C反应蛋白(hs-CRP)的检测对心肌梗死患者静脉溶栓效果预测的重要性.方法 2003年8月到2007年12月间指标性疼痛发生6 h内接受静脉内溶栓治疗的ST段抬高心肌梗死(STEMI)连续患者共372例,溶栓失败是以静脉溶栓开始后90 min内ST段恢复≤50%来认定.结果心肌梗死患者静脉溶栓失败率为57.4%,多变量Logistic回归分析BNP组(RR 1.5;95%CI 1.1～1.8,P=0.004高/中组;RR 2.2,95% CI 1.9～3.5,P=0.001高/低组;RR 1.5,95%CI 1.2～1.8,P=0.001中/低组)和hs-CRP组(RR 2.0,95%CI 1.6～2.2;P=0.001高/中组;RR 2.6,,95%CI 2.1～3.5,P=0.001高/低组;RR 1.3,95%CI 1.2～1.7,P=0.02中/低组).均与溶栓失败的发生率显著相关.结论研究结果表明循环中BNP和hs-CRP的升高与溶栓失败的发生率显著相关.
목적 통과지속12-도련ECG ST단감측,평고혈액중B형뇨납태(BNP)、고민C반응단백(hs-CRP)적검측대심기경사환자정맥용전효과예측적중요성.방법 2003년8월도2007년12월간지표성동통발생6 h내접수정맥내용전치료적ST단태고심기경사(STEMI)련속환자공372례,용전실패시이정맥용전개시후90 min내ST단회복≤50%래인정.결과 심기경사환자정맥용전실패솔위57.4%,다변량Logistic회귀분석BNP조(RR 1.5;95%CI 1.1～1.8,P=0.004고/중조;RR 2.2,95% CI 1.9～3.5,P=0.001고/저조;RR 1.5,95%CI 1.2～1.8,P=0.001중/저조)화hs-CRP조(RR 2.0,95%CI 1.6～2.2;P=0.001고/중조;RR 2.6,,95%CI 2.1～3.5,P=0.001고/저조;RR 1.3,95%CI 1.2～1.7,P=0.02중/저조).균여용전실패적발생솔현저상관.결론 연구결과 표명순배중BNP화hs-CRP적승고여용전실패적발생솔현저상관.
Objective To investigate the role of combined detection of brain natriuretic peptide (BNP) and high-sensitivity C reactive protein (hs-CRP) in efficiency evaluation of venous thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) by using continuous 12-lead ECG ST-segment monitoring. Methods A total of 372 patients with consecutive STEMI were enrolled in the investigation who received intravenous thrombolysis in the first 6 h after classical ache onset from August 2003 to December 2007. Failed thrombolysis was defined as the absence of abrupt and sustained ST-segment recovery (＞50%) in the first 90 min after the initiation of intravenous thrombolysis. Results The incidence of failed thrombolysis was 57.4% in the patients with myocardial infarction. The multivariable logistic regression analysis showed both BNP (RR 1.5, 95% CI 1.1-1.8, P=0. 004 for high/medium group; RR 2.2, 95% CI 1.9-3.5, P= 0. 001 for high/low group;RR 1.5, 95% CI 1.2-1.8, P=0. 001 for medium/low group) and hs-CRP (RR 2.0, 95% CI 1.6-2.2, P=0.001 for high/medium group; RR 2.6, 95% CI 2.1-3.5, P=0. 001 for high/low group;RR 1.3, 95% CI 1.2-1.7, P=0.02 for medium/low group) were independently associated with failed thrombolysis. Conclusion High levels of circulating BNP and hs-CRP are closely related to the incidence of failed thrombolysis.