Clinical Significance Of Brain Natriuretic Peptide Combined With Hypersensitive C Reactive Protein And D-dimer In Acute Myocardial Infarction

backgrounds and objections:Acute Myocardial Infarction (AMI) means necrosis of heart muscle due to the sudden deprivation of circulating blood.It is usually caused by arteriosclerosis with narrowing of the coronary arteries, the culminating event being a thrombosis. It is a significant public health problem in the developped countries with high morbidity and mortality. However, it is also very common in our counrry as the change of life style. So it seems important to distinguise it timely and assess the state of the patient accurantly. Many laboratory examinations including cardiac biomarkers make change in AMI. There are scores of studies on brain natriuretic peptide (BNP), hypersensitive C reactive protein (hs-CRP) and D-dimer (D-D) in the cardiovascular disease. And we will explore the clinical value of BNP, hs-CRP and D-D in patients after acute myocardial infarction in this article.Research Methods: We chosed 37 AMI patients (AMI group) including 23 males and 14 females in the first clinical hospital of Jilin University From March 2008 to March 2009 at random. At the same time, 12 males and 8 females without AMI were chosed as contorl (Ctrl group). The blood samples were obtained within 24 hours after the onset of AMI were separated by centrifugation immediately and they were tested immediately or within 24 hours under 4℃. The samples for BNP were collected in plastic collection tubes and were tested with AxSYM System using the technique of Microparticle Enzyme Immunoassay (MEIA). Both D-D (provided by Beckman Coulter company) and hs-CRP (provided by Dade Behring company) are tested with turbidimetric immunoassay.The damage of coronary artery is described by Gensini Score Systerm according to angiography. The qualitative data of clinical and laboratory examination on present as percentage,and the quantitative data present as mean±standard deviation. All tests were performed 2-sided and a significance level of p<0.05 was considered to indicate statistical significance. For all statistical analyses, the statistical software SPSS 11.5 (SPSS Inc., Chicago, Illinois) for Windows was used.Results:1. The average age in Ctrl group, AMI group, Killip I group (KI) and KillipⅡ-Ⅳgroup (KⅡ-Ⅳ) is 61.30±7.87, 62.86±10.46, 61.04±9.86 and 64.18±11.03.The proportion of male patient in Ctrl group, AMI group, KI and KⅡ-Ⅳis 60.00%, 62.16%, 61.54%, 63.64%. The proportion of diabetes in Ctrl group, AMI group, KI and KⅡ-Ⅳis 25.00%, 24.32%, 23.08%, 27.28%. The proportion of hypertention in Ctrl group, AMI group, KI and KⅡ-Ⅳis 35.00%, 35.14%, 34.62%, 36.37%. The proportion of hyperlipidemia in Ctrl group, AMI group, KI and KⅡ-Ⅳis 45.00%, 43.95%, 42.31%, 45.46%. There are 50.00%, 54.35%, 53.85%, 54.55% smokers and 10.00%, 10.81%, 11.54%, 9.10% drinkers in Ctrl group, AMI group, KI and KⅡ-Ⅳgroup.2. BNP, hs-CRP, D-D and CTn-I in Ctrl group is 46.10±27.25pg/ml, 1.24±1.17mg/L, 0.16±0.08ug/ml, 0.06±0.05ng/ml. BNP, hs-CRP, D-D and CTn-I in AMI group is 408.27±607.00 pg/ml, 6.40±6.30 mg/L, 0.66±1.30ug/ml, 7.36±20.03ng/ml. BNP, hs-CRP, D-D and CTn-I in K I group is 176.30±146.84 pg/ml, 4.63±3.77mg/L, 0.32±0.29ug/ml, 8.43±23.39ng/ml. BNP, hs-CRP, D-D and CTn-I in KⅡ-Ⅳgroup is 956.56±895.52pg/ml, 10.60±8.93 mg/L, 0.67±0.62ug/ml, 16.59±32.75ng/ml.3. The BNP, hs-CRP, D-D and CTn-I levels in AMI are all higher than in Ctrl group (t=3.623, p=0.001; t=4.830, p<0.01; t=2.344, p=0.025; t=2.185, p=0.035) and the BNP, hs-CRP,and D-D levels in KⅡ-Ⅳare all higher than in K I group (t=-2.873, p=0.016; t=-2.894, p=0.007; t=-2.322, p=0.026;)but there is no significant differenc in CTn-I level(t=-0.859, p=0.396).4. The proportion of 3- coronary artery damaged, 2- coronary artery damaged, 1-coronary artery damaged, only LAD damaged, only RCA damaged and only LCX damaged is 14%, 16%, 32%, 27% and 11%. The BNP, hs-CRP, D-D and CTn-I levels in 1- coronary artery damaged group is 170.55± 141.57pg/ml, 4.25±3.06mg/L, 0.41±0.49ug/ml, 11.40±30.38ng/ml. The BNP, hs-CRP, D-D and CTn-I levels in 2- coronary artery damaged group is 422.07±319.03pg/ml, 8.13±5.69mg/L, 0.37±0.20ug/ml, 3.87±8.24ng/ml. The BNP, hs-CRP, D-D and CTn-I levels in 3-coronary artery damaged group is 1627.88±914.72pg/ml, 15.52±10.94mg/L, 0.48±0.36ug/ml, 16.56±15.97ng/ml.5. The BNP in 3- coronary artery damaged group is higher than in 2- coronary artery damaged group and 1- coronary artery damaged group (t=3.042, p=0.014; t=-3.554, p=0.023). But there is no difference between 1- coronary artery damaged group and 2- coronary artery damaged group (t=-1.889, p=0.113). hs-CRP, D-D and CTn-I seem do not related with the number of damaged coronary artery (hs-CRP t3-2=1.446, p=0.182; t3-1=-2.287, p=0.082; t2-1=-2.365, p=0.025. D-D t3-2=0.596, p=0.573; t3-2=-0.290,p=0.774 ; t2-1=-0.195, p=0.846. CTn-I t3-2=1.704, p=0.123 t3-1=-0.366 p=0.717; t2-1=0.595 p=0.556).6. BNP level is related to hs-CRP level (r=0.605, P<0.01). There is no relationship between BNP and D-D (r=0.078,p=0.644). There is no relationship between hs-CRP and D-D (r=0.034,p=0.842).7. BNP and hs-CRP level are both related to Gensini Score (r=0.760, P<0.01; r=0.582, P<0.01). There is no relationship between D-D and Gensini Score (r=0.161, p=0.406).Conclusions:1. The BNP, hs-CRP and D-D levels in AMI are all higher than in Ctrl group and all of them in KⅡ-Ⅳare all higher than in KⅠgroup. The BNP in 3- coronary artery damaged group is higher than in 2- coronary artery damaged group and 1- coronary artery damaged group.2. BNP level is related to hs-CRP level. BNP and hs-CRP level are both related to Gensini Score.