CAJ | 학술논문

目的探讨D-二聚体和超敏C-反应蛋白(hs-CRP)对早期诊断老年冠心病并判断其急危重症的临床意义.方法 122例老年冠心痛患者,分为4个亚组:陈旧性心肌梗死(OM1)组27例、稳定型心绞痛(SAP)组29例、急性冠状动脉综合征(ACS)组32例、陈旧性心肌梗死新发急性冠状动脉综合征(OMI+ACS)组34例.30例非冠心病患者作为对照组.应用免疫比浊法测定各组的hs-CRP,应用免疫散射法测定各组的D-二聚体,并进行比较分析.结果各组间患者D-二聚体水平进行两两比较,OMI组[(0.25±007)mg/L]与SAP组[(0.27±0.08)mg/L]、OMI+ACS组[(0.58±0.80)mg/L]与ACS组[(0.56±0.72)mg/L]差异均无统计学意义(P均>0.05);OMI组与对照组比较差异有统计学意义(P<0.05);其余各组间比较差异均有统计学意义(P均<0.01).各组间患者hs-CRP水平进行两两比较,OMI组[(3.76±0.61)mg/L]与SAP组[(3.90±0.81)mg/L]、OMI+ACS组[(6.57±2.09)mg/L]与ACS组[(6.19±1.84)mg/L]差异均无统计学意义(P均>0.05);其余各组差异均有统计学意义(P均<0.01).老年冠心病患者D-二聚体与hs-CRP水平之间存在显著正相关(r=0.81,P<0.01).结论 D-二聚体和hs-CRP可作为判断老年人冠心病发生或存在的指标.D-二聚体和hs-CRP可作为临床判断冠状动脉斑块是否处于稳定期,是否发生急性冠状动脉综合征的指标;可作为陈旧性心肌梗死患者是否新发急性冠状动脉综合征的指标.但不能用于鉴别发生急性冠状动脉综合征的患者是否已经存在陈旧性心肌梗死.老年冠心病患者D-二聚体与hs-CRP水平存在正相关性.
목적 탐토D-이취체화초민C-반응단백(hs-CRP)대조기진단노년관심병병판단기급위중증적림상의의.방법 122례노년관심통환자,분위4개아조:진구성심기경사(OM1)조27례、은정형심교통(SAP)조29례、급성관상동맥종합정(ACS)조32례、진구성심기경사신발급성관상동맥종합정(OMI+ACS)조34례.30례비관심병환자작위대조조.응용면역비탁법측정각조적hs-CRP,응용면역산사법측정각조적D-이취체,병진행비교분석.결과 각조간환자D-이취체수평진행량량비교,OMI조[(0.25±007)mg/L]여SAP조[(0.27±0.08)mg/L]、OMI+ACS조[(0.58±0.80)mg/L]여ACS조[(0.56±0.72)mg/L]차이균무통계학의의(P균>0.05);OMI조여대조조비교차이유통계학의의(P<0.05);기여각조간비교차이균유통계학의의(P균<0.01).각조간환자hs-CRP수평진행량량비교,OMI조[(3.76±0.61)mg/L]여SAP조[(3.90±0.81)mg/L]、OMI+ACS조[(6.57±2.09)mg/L]여ACS조[(6.19±1.84)mg/L]차이균무통계학의의(P균>0.05);기여각조차이균유통계학의의(P균<0.01).노년관심병환자D-이취체여hs-CRP수평지간존재현저정상관(r=0.81,P<0.01).결론 D-이취체화hs-CRP가작위판단노년인관심병발생혹존재적지표.D-이취체화hs-CRP가작위림상판단관상동맥반괴시부처우은정기,시부발생급성관상동맥종합정적지표;가작위진구성심기경사환자시부신발급성관상동맥종합정적지표.단불능용우감별발생급성관상동맥종합정적환자시부이경존재진구성심기경사.노년관심병환자D-이취체여hs-CRP수평존재정상관성.
Objective To investigate the clinical significance of the levels of D-dimer and hs-CRP in the elderly patients with coronary disease. Methods One hundred and twenty-two patients with coronary disease were divided into four groups according to their clinical manifestations, there were old myocardial infarction group ( OMI, n =27 ) , stable angina pectoris group ( SAP, n = 29), acute coronary syndromes group ( ACS, n = 32) and old myocardial infarction with acute cardiovascular syndrome group (OMI + ACS,n =34). The control group included the patients without coronary disease (n =30). The patients who had infection, malignant tumors, liver and kidney dysfunction, cerebral infarction, venous embolism in lower extremities and pulmonary embolism were not included, and the patients enrolled should not be on medication of antiplatelet drugs, anticoagulants and antibiotics within the last two weeks. The levels of D-dimer and hs-CRP in all groups were determined by immunoturbidimetric assay and immune scattering assay respectively. Results In each comparison between two groups, the level of D-dimer has no significant difference between the OMI and the SAP ( P > 0. 05 ) , ACS and the OMI + ACS ( P > 0. 05 ) ; but significant difference between the OMI and the control groups ( P < 0. 05) and more significant difference between the other groups were found (P < 0. 01). As for the level of hs-CRP, there was no significant difference between the OMI and the SAP groups (P > 0. 05) or between the ACS and the OMI + ACS groups (P > 0. 05); but significant difference between the other groups (P < 0. 01). the positive relationship between the levels of D-dimer and hs-CRP have in coronary disease in the elderly patients was also found(r = 0. 81 ,P <0.01). Conclusions D-dimer and hs-CRP can be used as the clinical makers to predict the occurrence of the coronary disease in the elderly patients. D-dimer and hs-CRP can be used as the clinical makers to determine the stability of cardiovascular atherosclerotic plaque and the risk of acute cardiovascular syndrome occurrence. They can also be used as the clinical makers to predict the recurrence of the acute cardiovascular syndrome in the patients with old myocardial infarction. However, they can not be used to determine whether the patients with acute cardiovascular syndrome had old myocardial infarction already or not. The levels of D - dimer and hs - CRP are closely related in coronary disease in the elderly patients.