全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2014年
1期
12-15
,共4页
糖尿病心肌病%糖化血红蛋白%同型半胱氨酸%B型脑钠肽
糖尿病心肌病%糖化血紅蛋白%同型半胱氨痠%B型腦鈉肽
당뇨병심기병%당화혈홍단백%동형반광안산%B형뇌납태
diabetic cardiomyopathy%hemoglobin A1c%homocysteine%B-type natriuretic peptide
目的：探讨糖尿病心肌病（DCM）患者糖化血红蛋白（HbA1c）、同型半胱氨酸（Hcy）和B型脑钠肽（BNP）联合检测的临床价值。方法选择确诊的DCM患者、糖尿病患者及对照组各59例，采用高压液相色谱法测定血浆HbA1c水平、速率法测定血清Hcy水平和双抗体夹心免疫荧光法测定血浆BNP浓度，根据美国纽约心脏病协会心功能分级(NYHA)标准和HbA1c水平分为：DCM 1组（HbA1c≤6.0%，心功能正常者）21例、DCM 2组（HbA1c 6.1%~9.0%，NYHA 2级）22例和DCM 3组（HbA1c＞9.0%，NYHA 3~4级）16例，比较不同HbA1c水平DCM患者和对照组的Hcy、BNP指标；分析各种指标单独及联合检测诊断DCM的灵敏度和特异度。结果 DCM组HbA1c、Hcy和BNP的浓度明显高于糖尿病组和对照组，差异均有统计学意义（t分别=2.82、2.38、2.22、2.12、2.54、2.48，P均＜0.05），且糖尿病组也明显高于对照组，差异均有统计学意义（t分别=2.91、2.42、2.67，P均＜0.05）；随着HbA1c水平的增高， DCM3组中Hcy和BNP的表达量明显高于DCM 1组、DCM 2组和对照组，差异均有统计学意义（t分别=3.18、2.71、2.55、2.96、2.61、2.30，P均＜0.05），且DCM 2组两指标的浓度也明显高于DCM 1组和对照组，差异均有统计学意义（t分别=2.98、2.63、2.44、2.20，P均＜0.05）；运用三种指标联合检测的灵敏度最高，但其检测的特异度降低。结论HbA1c水平与糖尿病心血管病变密切相关，联合检测HbA1c、Hcy及BNP，可作为监测DCM发生的敏感指标，对于DCM的早期预防及诊断有重要意义。
目的：探討糖尿病心肌病（DCM）患者糖化血紅蛋白（HbA1c）、同型半胱氨痠（Hcy）和B型腦鈉肽（BNP）聯閤檢測的臨床價值。方法選擇確診的DCM患者、糖尿病患者及對照組各59例，採用高壓液相色譜法測定血漿HbA1c水平、速率法測定血清Hcy水平和雙抗體夾心免疫熒光法測定血漿BNP濃度，根據美國紐約心髒病協會心功能分級(NYHA)標準和HbA1c水平分為：DCM 1組（HbA1c≤6.0%，心功能正常者）21例、DCM 2組（HbA1c 6.1%~9.0%，NYHA 2級）22例和DCM 3組（HbA1c＞9.0%，NYHA 3~4級）16例，比較不同HbA1c水平DCM患者和對照組的Hcy、BNP指標；分析各種指標單獨及聯閤檢測診斷DCM的靈敏度和特異度。結果 DCM組HbA1c、Hcy和BNP的濃度明顯高于糖尿病組和對照組，差異均有統計學意義（t分彆=2.82、2.38、2.22、2.12、2.54、2.48，P均＜0.05），且糖尿病組也明顯高于對照組，差異均有統計學意義（t分彆=2.91、2.42、2.67，P均＜0.05）；隨著HbA1c水平的增高， DCM3組中Hcy和BNP的錶達量明顯高于DCM 1組、DCM 2組和對照組，差異均有統計學意義（t分彆=3.18、2.71、2.55、2.96、2.61、2.30，P均＜0.05），且DCM 2組兩指標的濃度也明顯高于DCM 1組和對照組，差異均有統計學意義（t分彆=2.98、2.63、2.44、2.20，P均＜0.05）；運用三種指標聯閤檢測的靈敏度最高，但其檢測的特異度降低。結論HbA1c水平與糖尿病心血管病變密切相關，聯閤檢測HbA1c、Hcy及BNP，可作為鑑測DCM髮生的敏感指標，對于DCM的早期預防及診斷有重要意義。
목적：탐토당뇨병심기병（DCM）환자당화혈홍단백（HbA1c）、동형반광안산（Hcy）화B형뇌납태（BNP）연합검측적림상개치。방법선택학진적DCM환자、당뇨병환자급대조조각59례，채용고압액상색보법측정혈장HbA1c수평、속솔법측정혈청Hcy수평화쌍항체협심면역형광법측정혈장BNP농도，근거미국뉴약심장병협회심공능분급(NYHA)표준화HbA1c수평분위：DCM 1조（HbA1c≤6.0%，심공능정상자）21례、DCM 2조（HbA1c 6.1%~9.0%，NYHA 2급）22례화DCM 3조（HbA1c＞9.0%，NYHA 3~4급）16례，비교불동HbA1c수평DCM환자화대조조적Hcy、BNP지표；분석각충지표단독급연합검측진단DCM적령민도화특이도。결과 DCM조HbA1c、Hcy화BNP적농도명현고우당뇨병조화대조조，차이균유통계학의의（t분별=2.82、2.38、2.22、2.12、2.54、2.48，P균＜0.05），차당뇨병조야명현고우대조조，차이균유통계학의의（t분별=2.91、2.42、2.67，P균＜0.05）；수착HbA1c수평적증고， DCM3조중Hcy화BNP적표체량명현고우DCM 1조、DCM 2조화대조조，차이균유통계학의의（t분별=3.18、2.71、2.55、2.96、2.61、2.30，P균＜0.05），차DCM 2조량지표적농도야명현고우DCM 1조화대조조，차이균유통계학의의（t분별=2.98、2.63、2.44、2.20，P균＜0.05）；운용삼충지표연합검측적령민도최고，단기검측적특이도강저。결론HbA1c수평여당뇨병심혈관병변밀절상관，연합검측HbA1c、Hcy급BNP，가작위감측DCM발생적민감지표，대우DCM적조기예방급진단유중요의의。
Objective To explore the clinical value of hemoglobin A1c(HbA1c), homocysteine(Hcy) and B-type natri-uretic peptide(BNP) in patients of diabetic cardiomyopathy(DCM). Methods Fifty-nine cases of DCM patients, diabetic patients and normal control in each were selected. The plasma HbA1c levels was detected by high-pressure liquid chro-matography method. Hcy level was detected by velocity method. The plasma BNP concentration was detected by double an-tibody sandwich immunoassay method. According to the New York heart association(NYHA) cardiac function classification standard and HbA1c level, the patients were divided into three group: DCM1 group which HbA1c was lower than 6.0%and cardiac function was normal, DCM2 group which HbA1c was from 6.1% to 9.0% and NYHA was grade two, DCM3 group which HbA1c was higher than 9.0% and NYHA was grade three and four. The Hcy and BNP levels between DCM patients and control group were compared in different HbA1c level. The sensitivity and specificity of using various indica-tors alone or combined to diagnose DCM were measured. Results HbA1c, Hcy and BNP concentration of DCM group were significantly higher than those of diabetic group and normal control group (t=2.82,2.38,2.22,2.12, 2.54,2.48, P<0.05). HbA1c,Hcy and BNP concentration of diabetic group was significantly higher than normal control group (t=2.91,2.42,2.67,P<0.05). With HbA1c levels increasing, the Hcy and BNP levels of the DCM3 group were significantly higher than those of DCM1group, DCM2 group and normal control group (t=3.18,2.71,2.55,2.96,2.61,2.30,P<0.05). The Hcy and BNP levels of the DCM2 group were significantly higher than those of DCM1 group and normal control group (t=2.98,2.63,2.44,2.20,P<0.05). Sensitivity of combined HbA1c, Hcy with BNP was highest, but specificity was lower. Conclusion The levels of HbA1c was closely re-lated to diabetic cardiovascular disease. Combined detecting HbA1c,Hcy and BNP as sensitive indicators of diabetic cardiomyopathy monitoring played an important role in early prevention and diagnosis of diabetic cardiomyopathy.
