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9MEDICAL SCIENCES
DETERMINATION OF NT-PROBNP LEVEL ACCORDING TO FLUORESCENT IMMUNITY METHOD AND RELATIONSHIP WITH TROPONIN-Ic IN ACUTE MYOCARDIAL INFARCTION CASES TREATED AT VIET TIEP FRIENDSHIP HOSPITAL,
VIETNAM
Vu Van Du
National Hospital of Obstetrics and Gynecology, Vietnam
Nguyen Thi Ngan
Haiphong University of Medicine and Pharmacy, Vietnam
Dao Van Tung
Haiphong University of Medicine and Pharmacy, Vietnam
ABSTRACT
The article explores the determination of NT-proBNP level in acute myocardial infarction and describes the relationship between NT-proBNP and Troponin Ic levels in acute myocardial infarction. The subject, method of study is a retrospective description using retrospective data from 123 patients diagnosed with acute myocardial infarction at Viet Tiep Friendship Hospital, Vietnam, from 10/2016-5/2017. Results: NT-proBNP levels in acute myocardial infarction patients increased as Killip: Killip 1 was 4015.2 +4116.8 pg/ml; Killip 2 is 13125.2 +7829.7 pg/ml; Killip 3 is 15174.6 +5693.9 pg/ml; Killip 4 is 115314.0 + 5681.2 pg/ml. NT-proBNP and Troponin I levels are moderately correlated in patients with acute myocardial infarction (r = 0.405; p <0.001). Results of the study indicate that NT-proBNP level in patients with acute myocardial infarction increased with Killip's degree and had a moderate correlation with Troponin I.
Keywords: NT-proBNP, Troponin I, myocardial infarction, acute syndrome, immunofluorescence, Vietnam.
1. Introduction
Myocardial infarction is a medical emergency that occurs due to ischemia in one area of the heart muscle leading to myocardial necrosis, if not detected and treated promptly, it will lead to many complications, including especially the complication of heart failure in the acute stage. Quantifying NT-proBNP and Troponin I levels in the blood not only helps diagnose this condition but also predicts the severity of myocardial infarction that affects the cardiac blood pumping function. Many studies have shown a correlation between Troponin I levels and myocardial infarct size with coronary artery damage. Therefore, the determination of NT-proBNP level in combination with Troponin I is necessary to accurately diagnose and predict complications after myocardial infarction. Therefore, we conduct this study aimed at: "Determination of NT-proBNP level in acute myocardial infarction patients and describing the relationship between NT-proBNP and Troponin Ic levels in patients with acute myocardial infarction".
2. Object and method of study
The study objects are patients with acute myocardial infarction who are being treated at Viet Tiep Friendship Hospital, Vietnam from October 2016 to May 2017. Their specimens are anticoagulant plasma with lithium.
Criteria for selection is patients who are diagnosed with acute myocardial infarction and agree to participate in the study.
Exclusion criteria is that patients who have been diagnosed with a previous myocardial infarction or coronary artery diseases, with captured damaged coronary angiography. Patients with severe medical conditions: liver failure, severe renal failure, cerebrovascular accident, cancer and etc.
Research Method. The study is conducted in a cross-sectional descriptive manner using retrospective data. Sample size: n = 123 patients.
Data collection method: The retrospective medical records of all patients diagnosed with acute myocardial infarction. Gather information via patient management codes on the basis of data available at the Department of Biochemistry and from the selected medical records at the Department of General Planning of Viet Tiep Friendship Hospital, Vietnam.
3. Study results
The study is conducted on 123 patients, with a significantly higher percentage of men than women (60.2% versus 39.8%). This finding is consistent with findings from domestic and international studies, which may be due to women before the age of 60 due to the effects of estrogen that should protect against atherosclerosis. In this study, the mean age of the women is higher than the mean age of the men, namely 74.1 + 9.07 compared to 68.5 + 13.4 (Table 1).
Table 1
General characteristics
Gender n X + SD p
Age Female 49 74.1 + 9.0 < 0.05
Male 74 68.5 + 13.4
Height (cm) Female 49 152.7 + 4.0 < 0.05
Male 74 164.8 + 2.6
Weight (kg) Female 49 60.7 + 7.02 < 0.05
Male 74 68.9 + 6.6
BMI (kg/m2) Female 49 25.9 + 2.8 > 0.05
Male 74 25.4 + 2.2
(Source: Author's summary from retrospective data)
Men have more risk factors than women, such as smoking habits, alcohol habits, work stress, prolonged stress, and so on. And also, these are favorable factors for coronary artery disease progression, especially myocardial infarction. BMI in both male and female
Pathological char
patients is higher than the normal value at 18.5 - 22.9. This indicates that overweight and obesity are one of the risk factors for myocardial infarction, along with other associated conditions such as diabetes mellitus, dyslipidemia and hypertension.
Table 2
teristics attached
Qty (n) Ratio %
Diabetes 41 33.3%
Dyslipidemia 79 64.3%
Hypertension 47 38.3%
(Source: Author's summary from retrospective data)
When studying NT-proBNP level in patients with 4015.2 ±4116.8 pg/ml in Killip 1 to 15314.0 ± 5681.2 myocardial infarction, we find that the heavier heart pg/ml / ml in Killip 4 (Table 3). failure corresponding to the higher Killip degree is, the higher the NT-ProBNP level is, specifically: from
Table 3
NT-proBNP, Troponin I levels and CK-MB activity at Killip levels
Killip 1 Killip 2 Killip 3 Killip 4 p
(n=87) (n=21) (n=8) (n = 7)
X + SD X + SD X + SD X + SD
CK-MB (U/l) 160.1+198.8 276.3+168.4 264.8+126.7 415.5+94.1 < 0.05
Troponin I (ng/l) 34.2+34.1 45.5+21.3 57.2+6.5 67.2+10.1 < 0.05
NT-proBNP (Pg/ml) 4015.2+4116.8 13125.2+7829.7 15174.6+5693.9 15314.0+5681.2 < 0.05
(Source: Author's summary from retrospective data)
The mechanism of NT-proBNP excretion is primarily from the strength of the myocardium, increased ventricular filling pressure and volume overload. NT-proBNP plasma increases in patients with heart failure and correlates with left ventricular filling. In some studies, a close correlation between
1 Hoang Anh Tien (2006). Research on the diagnostic value of B-type natriuretic peptide N-terminal (NT-ProBNP) level in chronic heart failure. Master thesis in medicine, Hue Medical University.
NT-proBNP level and NYHA heart failure rates is noted, for example: The study by Hoang Anh Tien shows a strong correlation with r = 0.9; p < 0.0011; The study by Nguyen Thi Thu Dung2 also concludes with correlation r = 0.67; P <0.001, corresponding to an increase in NT-proBNP levels: 1591 pg / ml, 3438 pg /
2 Nguyen Thi Thu Dung and partners (2010). Correlation of NT-proBNP with stages of cardiovascular heart failure. American Heart Association, Cardiology Theme.
ml, 5564 pg / ml corresponding to grade II heart failure, grade III heart failure, grade IV heart failure; Tran Viet An3 conducts a study of 1,483 patients with acute increased non- ST elevation syndrome, and left ventricular dysfunction at levels of: minor (EF 40-
Relationship between NT-proBNP
49%), mean (EF 30-39%) and major (EF <30%) corresponding to NT-proBNP levels: 333.7 pg / ml; 600.4 pg / ml; 1439.4 pg / ml. Significant increase in NT-proBNP levels is associated with a decrease in left ventricular function (p <0.0001) (Table 4).
Table 4
d Troponin I based on Killip levels
Correlation of NT-proBNP and Troponin
Common (n=123) Killip 1 (n=87) Killip 2 (n=21) Killip3 (n=8) Killip 4 (n=7)
Pearson Correlation (r) 0.405 0.320 0.643 0.669 0.557
p <0.001 <0.01 <0.01 <0.05 >0.05
(Source: Author's summary from retrospective data)
Thus, along with an increase in NYHA class of heart failure in chronic heart failure or Killip's acute stroke in acute myocardial infarction, NT-proBNP levels also increases significantly.
Several studies have demonstrated that the timing of quantification of NT-proBNP levels in patients with acute coronary syndrome is different: admission <24 hours or after 2-5 days after onset of symptoms4. The authors study the dynamics of NT-proBNP to find the best time to predict mortality or cardiovascular events in patients with acute coronary syndrome or complications of myocardial infarction. Quantify the patient's NT-proBNP level for 3 first hours after onset of symptoms within normal range and peak after 24 hours of ischemia5. In the FRISC-II study, NT-proBNP level is peaked at admission, decreased for 24 first hours, and gradually decreased after 6 months in non-ST segment elevated HCV patients6. In the PRISM study, an NT-proBNP level of 72 hours after admission, is a predictor of mortality or recurrent MI for 30 days7. In summary, the timing of quantification of serum NT-proBNP levels in patients with acute coronary syndrome is <24 hours after angina or 2-5 days to reflect left ventricular systolic dysfunction after acute coronary syndrome8.
Thus, when time for occurrence of myocardial infarction and myocardial infarction have a significant impact on NT-proBNP level, our study performs concurrently these indexes after the second day of
myocardial infarction cases to assess their relative level of severity of cardiac failure according to Killip's severity in myocardial infarction.
This study recognizes a correlation between NT-proBNP and Troponin with r = 0.405; And also, the correlation between NT-proBNP and Troponin tends to increase with the Killip levels. According to Tran Viet An9, when conducting the study on patients with acute coronary syndrome, the relationship between NT-proBNP and Troponin levels is observed: Patients is with Troponin levels <0.01 ^g / l, the NT-proBNP level is 204 ng / l. Patients is with troponin levels > 0.01 ^g / l; The serum NT-proBNP level is 1,639 ng /l. The correlation between serum NT-proBNP level and Troponin level is r = 0.45; P = 0.01. As myocardial necrolysis increases the area reflected by Troponin level, this wide area directly affects the cardiac muscle contractions expressed by increased NT-proBNP level.
Thus, NT-proBNP level in patients with acute myocardial infarction increases with Killip: Killip 1 level of 4015.2 ±4116.8 pg/ml; Killip 2 is 13125.2 +7829.7 pg/ml; Killip 3 is 15174.6 ±5693.9 pg/ml; Killip 4 is 15314.0 ± 5681.2 pg/ml. NT-proBNP level and Troponin I level are moderately correlated between NT-proBNP level and Troponin I level in patients with acute myocardial infarction (r = 0.405; p <0.001).
3 Tran Viet An (2009). The role of NT-proBNP levels in the prognosis of acute coronary syndrome. Can Tho University of Medicine, Cardiology Theme.
4 Morrow DA, Cannon CP, Jesse RL, et al (2007). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines, Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes, Circulation, No115, pp.e356-e375.
5 Gill D, Seidler T, Troughton R, et al (2004). Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction. Clinical Science, No106, pp.135-139.
6 Lindahl B, Lindbäck J, Jernberg T, et al (2005). Serial Anal-
yses of N-Terminal Pro-B-Type Natriuretic Peptide in Pa-
tients With Non-ST-Segment Elevation Acute Coronary Syn-
dromes. A Fragmin and Fast Revascularisation During Instability in Coronary Artery Disease (FRISC)-II Substudy, J Am Coll Cardiol, No45(4), pp.533-541.
7 Heeschen C, Hamm CW, Mitrovic V, et al (2004), "Stratification of Patients With Acute Coronary Syndromes N-Termi-nal Pro-B-Type Natriuretic Peptide Levels for Dynamic Risk", Circulation, No110, pp.3206-3212.
8 Morrow DA, Cannon CP, Jesse RL, et al (2007). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines. Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes, Circulation, No115, pp.e356-e375.
9 Tran Viet An (2009). The role of NT-proBNP levels in the prognosis of acute coronary syndrome. Can Tho University of Medicine, Cardiology Theme.
References
1. Gill D, Seidler T, Troughton R, et al (2004). Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction. Clinical Science, No106, pp.135-139.
2. Heeschen C, Hamm CW, Mitrovic V, et al
(2004). Stratification of Patients With Acute Coronary Syndromes N-Terminal Pro-B-Type Natriuretic Peptide Levels for Dynamic Risk. Circulation, No110, pp.3206-3212.
3. Hoang Anh Tien (2006). Research on the diagnostic value of B-type natriuretic peptide N-terminal (NT-ProBNP) level in chronic heart failure. Master thesis in medicine, Hue Medical University.
4. Lindahl B, Lindbäck J, Jernberg T, et al
(2005). Serial Analyses of N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes. A Fragmin and
Fast Revascularisation During Instability in Coronary Artery Disease (FRISC)-II Substudy, J Am Coll Cardiol, No45(4), pp.533-541.
5. Morrow D.A., Cannon CP, Jesse RL, et al (2007). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines. Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes. Circulation, No115, pp. e356-e375.
6. Nguyen Thi Thu Dung and partners (2010). Correlation of NT-proBNP with stages of cardiovascular heart failure. American Heart Association, Cardiology Theme.
7. Tran Viet An (2009). The role of NT-proBNP levels in the prognosis of acute coronary syndrome. Can Tho University of Medicine, Cardiology Theme.
ORGANIZATION AND CONDUCT OF CERTIFICATION OF PRODUCTION OBJECTS ON LABOR CONDITIONS OF LARGE
ENTERPRISES
Kaidakova N.N.
dmn RF, Academician RAE Kazakhstan Agency of Applied Ecology, Almaty
ОРГАНИЗАЦИЯ И ПРОВЕДЕНИЕ АТТЕСТАЦИИ ПРОИЗВОДСТВЕННЫХ ОБЪЕКТОВ ПО УСЛОВИЯМ ТРУДА
КРУПНЫХ ПРЕДПРИЯТИЙ
Кайдакова Н.Н.
дмн РФ, Академик РАЕ Казахстанское Агентство прикладной экологии, Алматы
ABSTRACT
Optimization of management of the certification of production facilities on the working conditions of large enterprises in KAPE is provided by recruiting unoccupied personnel, by training them for a brigade method of conducting laboratory research. It provides adequate resource hardware (instrumentation) support for the team and the use of its own computer program for the automated processing of attestation materials. Economic control and evaluation of the effectiveness of the results can reduce the time and resource costs for the implementation of projects.
АННОТАЦИЯ
Оптимизация управления аттестацией производственных объектов по условиям труда крупных предприятий в КАПЭ обеспечивается привлечением не занятого персонала, его обучением для бригадного метода проведения лабораторных исследований. Обеспечивается адекватное ресурсное аппаратное (приборное) обеспечение бригады и использование собственной компьютерной программы для автоматизированной обработки материалов аттестации. Экономический контроль и оценка эффективности результатов позволяет снизить временные и ресурсные затраты на выполнение проектов.
Keywords: certification of workplaces, working conditions, automated processing.
Ключевые слова: аттестация производственных объектов по условиям труда, условия труда, автоматизированная обработка.
Постановка проблемы. Сектор медицинского и санитарно-эпидемиологического анализа Казахстанского Агентства прикладной экологии (КАПЭ) был создан в 2002 году. В то время единственная медицинская структура в Республике Казахстан в
системе экологических организаций. Сектор обеспечивал грамотное сопровождение оценки антропогенного воздействия намечаемой хозяйственной деятельности на здоровье населения в экологических проектах организации.
