Prognosticheskaya znachimost' urovnya mozgovogo natriyureticheskogo peptida u bol'nykh, perenesshikh obostrenie ishemicheskoy bolezni serdtsa


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Прогнозирование течения заболевания у пациентов с высоким риском неблагоприятного исхода ишемической болезни сердца (ИБС) имеет большое значение для разработки индивидуальной стратегии лечения. Нами изучен вклад уровня мозгового натрийуретического пептида (МНП) в оценку риска у больных, перенесших обострение ИБС. Обследованы 324 больных, срок наблюдения - 2 года. Пациентов включали в исследование на 10-й день от начала развития острого коронарного синдрома при условии стабилизации состояния. На момент включения в исследование 55,1 % больных был поставлен диагноз инфаркта миокарда (ИМ) с формированием Q зубца, 18,5 % - ИМ без Q, 25,5 % - нестабильная стенокардия. В среднем уровень МНП составлял 624,514 ± 32,13 (от 70,3 до 4276,6) фмоль/мл. У больных с последующим неблагоприятным исходом его уровень составил 872,47 ± 91,42 против 592,45 ± 35,97 фмоль/мл у пациентов без неблагоприятных сердечно-сосудистых событий (р = 0,001). Многофакторный анализ Кокса продемонстрировал, что с развитием фатальных и нефатальных ИМ и инсультов независимо ассоциированы повышенный уровень МНП (р < 0,0001), симптоматический атеросклероз периферических артерий (р < 0,0001) и ИМ в анамнезе (р = 0,001). Таким образом, у больных острым коронарным синдромом показана достоверная ассоциация повышения уровня МНП с неблагоприятным клиническим исходом. Измерение МНП может способствовать идентификации группы пациентов высоко риска, что необходимо для разработки индивидуальной стратегии лечения таких больных.

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