中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
13期
2381-2384
,共4页
程庆荣%袁雷%喻友萍%李结华
程慶榮%袁雷%喻友萍%李結華
정경영%원뢰%유우평%리결화
急性冠状动脉综合征%利钠肽,脑%C反应蛋白质%D-二聚体
急性冠狀動脈綜閤徵%利鈉肽,腦%C反應蛋白質%D-二聚體
급성관상동맥종합정%리납태,뇌%C반응단백질%D-이취체
Acute coronary syndrome%Natriuretic peptide,brain%C-reactive protein%D-Dimer
目的：探讨老年急性冠状动脉综合征（ACS）中血浆B型脑钠肽（BNP）、D-二聚体（D-D）和超敏C反应蛋白（hs-CRP）水平的变化及其与预后的关系。方法118例老年ACS患者按临床类型分为：急性心肌梗死（AMI）组60例，不稳定型心绞痛（UAP）组58例，同期入选体检健康者45例作为对照组。检测各组血浆BNP、D-D和hs-CRP值及超声心动图检测左心室射血分数（LVEF），比较各组三指标间的差异；AMI组患者根据Killip分级行心功能分级，同时按BNP水平分为四个等级，比较分析Killip心功能分级与BNP水平的关系；所有患者平均随访1年，观察随访期间的药物治疗和主要不良临床事件的发生率。结果 AMI组血浆3项指标明显高于UAP组（P＜0.05），UAP 组明显高于对照组（P＜0.05）；AMI 组中，Killip 分级Ⅱ～Ⅳ级者共35例，按BNP 水平分级2～4级者分别为7、12、16例，BNP 水平4级患者数与其他三组相比，差异明显（P＜0.05）；BNP水平3级与1、2级相比，差异有统计学意义（P＜0.05）。BNP、D-D均升高者发生不良临床事件的次数明显高于都正常者（P＜0.05）；BNP、D-D中仅一项高的患者组比较略有差异，无统计学意义（P＞0.05）。结论 BNP、D-D和hs-CRP的水平反映心肌缺血损伤的程度，联合分析有助于老年ACS患者的临床诊断、危险分层及预后评估。
目的：探討老年急性冠狀動脈綜閤徵（ACS）中血漿B型腦鈉肽（BNP）、D-二聚體（D-D）和超敏C反應蛋白（hs-CRP）水平的變化及其與預後的關繫。方法118例老年ACS患者按臨床類型分為：急性心肌梗死（AMI）組60例，不穩定型心絞痛（UAP）組58例，同期入選體檢健康者45例作為對照組。檢測各組血漿BNP、D-D和hs-CRP值及超聲心動圖檢測左心室射血分數（LVEF），比較各組三指標間的差異；AMI組患者根據Killip分級行心功能分級，同時按BNP水平分為四箇等級，比較分析Killip心功能分級與BNP水平的關繫；所有患者平均隨訪1年，觀察隨訪期間的藥物治療和主要不良臨床事件的髮生率。結果 AMI組血漿3項指標明顯高于UAP組（P＜0.05），UAP 組明顯高于對照組（P＜0.05）；AMI 組中，Killip 分級Ⅱ～Ⅳ級者共35例，按BNP 水平分級2～4級者分彆為7、12、16例，BNP 水平4級患者數與其他三組相比，差異明顯（P＜0.05）；BNP水平3級與1、2級相比，差異有統計學意義（P＜0.05）。BNP、D-D均升高者髮生不良臨床事件的次數明顯高于都正常者（P＜0.05）；BNP、D-D中僅一項高的患者組比較略有差異，無統計學意義（P＞0.05）。結論 BNP、D-D和hs-CRP的水平反映心肌缺血損傷的程度，聯閤分析有助于老年ACS患者的臨床診斷、危險分層及預後評估。
목적：탐토노년급성관상동맥종합정（ACS）중혈장B형뇌납태（BNP）、D-이취체（D-D）화초민C반응단백（hs-CRP）수평적변화급기여예후적관계。방법118례노년ACS환자안림상류형분위：급성심기경사（AMI）조60례，불은정형심교통（UAP）조58례，동기입선체검건강자45례작위대조조。검측각조혈장BNP、D-D화hs-CRP치급초성심동도검측좌심실사혈분수（LVEF），비교각조삼지표간적차이；AMI조환자근거Killip분급행심공능분급，동시안BNP수평분위사개등급，비교분석Killip심공능분급여BNP수평적관계；소유환자평균수방1년，관찰수방기간적약물치료화주요불량림상사건적발생솔。결과 AMI조혈장3항지표명현고우UAP조（P＜0.05），UAP 조명현고우대조조（P＜0.05）；AMI 조중，Killip 분급Ⅱ～Ⅳ급자공35례，안BNP 수평분급2～4급자분별위7、12、16례，BNP 수평4급환자수여기타삼조상비，차이명현（P＜0.05）；BNP수평3급여1、2급상비，차이유통계학의의（P＜0.05）。BNP、D-D균승고자발생불량림상사건적차수명현고우도정상자（P＜0.05）；BNP、D-D중부일항고적환자조비교략유차이，무통계학의의（P＞0.05）。결론 BNP、D-D화hs-CRP적수평반영심기결혈손상적정도，연합분석유조우노년ACS환자적림상진단、위험분층급예후평고。
Objective To investigate the changes of b-type brain natriuretic peptide (BNP), D-dimer(D-D) and hypersensitive C-reactive protein (hs-CRP) in plasma levels of the elderly acute coronary syndrome (ACS) of and its relationship with prognosis.MethodsThe total of 118 elderly ACS by clinical types were enrolled, include: acute myocardial infarction (AMI) group of 60 cases, unstable angina (UAP) group of 58 cases, and the healthy control group of 45 cases. Plasma levels of BNP, D-D and hs-CRP were detected, and left ventricular ejection fraction(LVEF) were detected by ultrasonic cardiogram; the clinical significances of BNP in every group were analyzed. The AMI patients according to the grade of cardiac function, Killip classification line, and the BNP levels can be divided into four grades, Killip cardiac function classification are compared with those of the BNP level. All patients were followed up for 1 year on average, to observe the follow-up period of drug therapy and the incidence of major adverse cardiac events (MACE).Results Plasma levels of BNP, hs-CRP, D-D in AMI group were significantly higher than those in UAP group(P<0.05), and in UAP group were significantly higher than those in control group (P<0.05). In AMI group, Killip classⅡ-Ⅳ 21 cases and 14 cases respectively, Compared with the four levels of BNP and the other three groups had significantly(P<0.05). Compared with the three levels of BNP and the one, two levels of BNP had significantly(P<0.05). The numbers of adverse clinical events in the elevated individual of BNP, D-D was higher than the individual of normal(P<0.05), and only a high of BNP, D-D in patients was slightly different(P>0.05).Conclusion The levels of BNP D-D and hs-CRP react degree of myocardial ischemia damage, conjoint analysis can be used as a clinical diagnosis, risk stratification of elderly ACS and prognosis judgement of a noninvasive quantitative indicators.
