重庆医学
重慶醫學
중경의학
Chongqing Medicine
2015年
31期
4338-4342
,共5页
急性冠脉综合征%氨基末端脑钠肽前体%高敏C反应蛋白%左室射血分数%冠状动脉病变程度
急性冠脈綜閤徵%氨基末耑腦鈉肽前體%高敏C反應蛋白%左室射血分數%冠狀動脈病變程度
급성관맥종합정%안기말단뇌납태전체%고민C반응단백%좌실사혈분수%관상동맥병변정도
acute coronary syndrome%natriuretic peptide,brain%C-reative protein%cardiac output%degress of coronary arterial stenosis
目的：探讨血浆NT‐proBNP、hs‐CRP水平和彩色多普勒超声心动图与急性冠状动脉综合征（ACS）早期缺血坏死及冠状动脉病变严重程度的相关性。方法选择2013年3月至2014年2月因胸痛入住该院的患者，采集病史，所有患者入院24 h内测定血浆NT‐proBNP、hs‐CRP和cTnT水平，记录超声心动图左室射血分数（LVEF）值和右室舒张末内径（LVEDd）值，且住院期间行冠状动脉造影确诊。根据病史、心电图、冠状动脉造影、cTnT 结果分为ST 段抬高型心肌梗死（STEMI）组、非ST 段抬高型心肌梗死（NSTEMI）组、不稳定型心绞痛（UA）组及对照组。冠状动脉病病变严重程度根据冠状动脉造影结果分为单支病变组、双支病变组、三支病变组和阴性对照组。分析血浆NT‐proBNP、hs‐CRP水平及LVEF值在各组间的差异，多因素线性回归分析判断其是否为血浆NT‐proBNP的独立性危险因素。结果入组ACS患者共102例。对照组（n＝40）、UA组（n＝40）分别与NSTEMI组（n＝30）、STEMI组（n＝32）比较，患者血浆NT‐proBNP、hs‐CRP水平及LVEF值差异均有统计学意义（P＜0．05）。阴性对照组（n＝40）和三支病变组（n＝41）分别与单支病变组（n＝30）、双支病变组（n＝31）比较，血浆NT‐proBNP水平差有统计学意义异（P＜0．05）。多因素线性回归分析示：血浆hs‐CRP水平（P＝0．007）、冠状动脉病变支数（P＝0．001）、糖尿病病史（P＝0．006）均为血NT‐proBNP水平的独立正相关因素，LVEF值（P＝0．036）则为血NT‐proBNP水平的独立负相关因素。结论血浆NT‐proBNP、hs‐CRP水平、LVEF值与ACS关系密切，可作为判断其早期缺血坏死程度和临床分型的重要参考指标。血浆NT‐proBNP水平有可能作为一种判断冠状动脉病变严重程度的分子标志物。
目的：探討血漿NT‐proBNP、hs‐CRP水平和綵色多普勒超聲心動圖與急性冠狀動脈綜閤徵（ACS）早期缺血壞死及冠狀動脈病變嚴重程度的相關性。方法選擇2013年3月至2014年2月因胸痛入住該院的患者，採集病史，所有患者入院24 h內測定血漿NT‐proBNP、hs‐CRP和cTnT水平，記錄超聲心動圖左室射血分數（LVEF）值和右室舒張末內徑（LVEDd）值，且住院期間行冠狀動脈造影確診。根據病史、心電圖、冠狀動脈造影、cTnT 結果分為ST 段抬高型心肌梗死（STEMI）組、非ST 段抬高型心肌梗死（NSTEMI）組、不穩定型心絞痛（UA）組及對照組。冠狀動脈病病變嚴重程度根據冠狀動脈造影結果分為單支病變組、雙支病變組、三支病變組和陰性對照組。分析血漿NT‐proBNP、hs‐CRP水平及LVEF值在各組間的差異，多因素線性迴歸分析判斷其是否為血漿NT‐proBNP的獨立性危險因素。結果入組ACS患者共102例。對照組（n＝40）、UA組（n＝40）分彆與NSTEMI組（n＝30）、STEMI組（n＝32）比較，患者血漿NT‐proBNP、hs‐CRP水平及LVEF值差異均有統計學意義（P＜0．05）。陰性對照組（n＝40）和三支病變組（n＝41）分彆與單支病變組（n＝30）、雙支病變組（n＝31）比較，血漿NT‐proBNP水平差有統計學意義異（P＜0．05）。多因素線性迴歸分析示：血漿hs‐CRP水平（P＝0．007）、冠狀動脈病變支數（P＝0．001）、糖尿病病史（P＝0．006）均為血NT‐proBNP水平的獨立正相關因素，LVEF值（P＝0．036）則為血NT‐proBNP水平的獨立負相關因素。結論血漿NT‐proBNP、hs‐CRP水平、LVEF值與ACS關繫密切，可作為判斷其早期缺血壞死程度和臨床分型的重要參攷指標。血漿NT‐proBNP水平有可能作為一種判斷冠狀動脈病變嚴重程度的分子標誌物。
목적：탐토혈장NT‐proBNP、hs‐CRP수평화채색다보륵초성심동도여급성관상동맥종합정（ACS）조기결혈배사급관상동맥병변엄중정도적상관성。방법선택2013년3월지2014년2월인흉통입주해원적환자，채집병사，소유환자입원24 h내측정혈장NT‐proBNP、hs‐CRP화cTnT수평，기록초성심동도좌실사혈분수（LVEF）치화우실서장말내경（LVEDd）치，차주원기간행관상동맥조영학진。근거병사、심전도、관상동맥조영、cTnT 결과분위ST 단태고형심기경사（STEMI）조、비ST 단태고형심기경사（NSTEMI）조、불은정형심교통（UA）조급대조조。관상동맥병병변엄중정도근거관상동맥조영결과분위단지병변조、쌍지병변조、삼지병변조화음성대조조。분석혈장NT‐proBNP、hs‐CRP수평급LVEF치재각조간적차이，다인소선성회귀분석판단기시부위혈장NT‐proBNP적독립성위험인소。결과입조ACS환자공102례。대조조（n＝40）、UA조（n＝40）분별여NSTEMI조（n＝30）、STEMI조（n＝32）비교，환자혈장NT‐proBNP、hs‐CRP수평급LVEF치차이균유통계학의의（P＜0．05）。음성대조조（n＝40）화삼지병변조（n＝41）분별여단지병변조（n＝30）、쌍지병변조（n＝31）비교，혈장NT‐proBNP수평차유통계학의의이（P＜0．05）。다인소선성회귀분석시：혈장hs‐CRP수평（P＝0．007）、관상동맥병변지수（P＝0．001）、당뇨병병사（P＝0．006）균위혈NT‐proBNP수평적독립정상관인소，LVEF치（P＝0．036）칙위혈NT‐proBNP수평적독립부상관인소。결론혈장NT‐proBNP、hs‐CRP수평、LVEF치여ACS관계밀절，가작위판단기조기결혈배사정도화림상분형적중요삼고지표。혈장NT‐proBNP수평유가능작위일충판단관상동맥병변엄중정도적분자표지물。
Objective To investigate the correlation between NT‐proBNP ,hs‐CRP level ,echocardiography and early avascu‐lar necrosis of coronary artery syndrome (ACS) ,coronary artery lesion degree .Methods 142 patients admitted in this hospital for chest pain from March 2013 to February 2014 were enrolled ,and all patients′history ,electrocardiogram (ECG) ,plasma levels of N‐terminal pro‐Brain Natriuretic Peptide (NT‐proBNP) ,hypersensitive C‐reative protein (hs‐CRP) and cTnT were recorded or tested within 24 hours ,while left ventricular ejection fraction (LVEF) and left ventricular end‐diastolic diameter (LVEDd) were recorded by echocardiography .According to the history and coronary angiography results conducted during hospitalization ,patients were di‐vided into acute ST segment elevation myocardial infarction (STEMI) group ,acute non‐ST segment elevation myocardial infarction (NSTEMI) group ,unstable angina pectoris (UA) group and control group (normal coronary angiography ,cTnT and ECG) .Pa‐tients with abnormal coronary angiography results were further divided into single vessel lesion group ,double vessel lesion group and triple vessel lesion group .The differences of plasma NT‐proBNP level ,hs‐CRP level and LVEF in each group ,and multivariate linear regression analysis were conducted to find out the independent risk factors for elevated plasma NT‐proBNP .Results 102 ACS patients and 40 normal patients were enrolled .Plasma levels of NT‐proBNP ,hs‐CRP and LVEF in NSTEMI group (n=30) and STEMI group (n=32) were significant different from UA group (n=40) and control group (n=40) respectively (P<0 .05) . The NT‐proBNP levels in control group and triple vessel lesion group (n=41) were respectively significant different from both sin‐gle vessel lesion group (n=30) and double vessel lesion group (n=31) (P<0 .05) .Multivariate linear regression analysis showed that ,plasma hs‐CRP level (P=0 .007) ,coronary artery lesion degree (P=0 .00) and history of diabetes (P=0 .006) were positive associated factors of NT‐proBNP level ,while LVEF was the negative associated factors of NT‐proBNP level(P=0 .036) .Conclusion Plasma NT‐proBNP level ,hs‐CRP level and LVEF are closely related to ACS ,and they might play an important role in determi‐ning the extent of early ischemic necrosis and clinical classification .Plasma NT‐proBNP level could be an important molecular mark‐er to reflect the degree of coronary artery lesion .
