不稳定型心绞痛患者血清cTnI、CK-MB、CRP水平变化及与心肌微循环状态的关系

目的探讨不稳定型心绞痛(UA)患者血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CKMB)、C反应蛋白(CRP)水平变化及与心肌微循环状态的关系。方法选取2019年2月至2020年7月于南京中医药大学附属盐城市中医院和江苏省苏州市相城人民医院就诊住院的109例心绞痛患者和54例同期体检健康者为研究对象,根据WHO分级标准分为稳定型心绞痛(SA)组44例、UA组65例、健康组54例,采用夹心酶联免疫吸附法、免疫抑制法、乳胶增强免疫透射比浊法分别检测3组研究对象血清cTnI、CK-MB、CRP水平,并记录其阳性检出率。UA组行冠状动脉造影(CAG),根据入院时的Braunwald分级标准另分为Ⅰ级低危险组20例、Ⅱ级中危险组23例、Ⅲ级高危险组22例,对比各危险组患者血清cTnI、CK-MB、CRP水平及阳性检出率,并分析UA组患者血清cTnI、CK-MB、CRP水平与心肌微循环状态关系。结果 UA组、SA组与健康组的血清cTnI、CK-MB、CRP水平及其阳性检出率由高到低均呈UA组>SA组>健康组变化(P<0.05)。高危险组、中危险组与低危险组的cTnI、CK-MB、CRP水平及其阳性检出率、病变血管支数组间两两比较,差异均无统计学意义(P>0.05);高危险组、中危险组与低危险组CTFC值由高到低呈高危险组>中危险组>低危险组变化(P<0.05)。UA组中cTnI、CK-MB、CRP检测结果为阳性者发生血管病变的比例均明显高于结果为阴性者(P<0.05)。结论 UA患者血清CK-MB、CRP水平较SA患者及健康人群高,其血清水平上调可能预测心肌微循环状态不良,临床监测上述指标对其具有重要诊断及鉴别价值。

Changes of serum cTnI,CK-MB and CRP levels in patients with unstable angina and their relationship with myocardial microcirculation

Objective To investigate the changes of serum troponin I(cTnI),creatine kinase isoenzyme MB(CK-MB)and C-reactive protein(CRP)levels in the patients with unstable angina(UA)and their relationship with the myocardial microcirculation status.Methods A total of 109 inpatients with angina pectoris treated in the two hospitals from February 2019 to July 2020 and 54 healthy people with physical examination during the same period were selected as the research subjects.According to the WHO classification standard,they were divided into the stable angina(SA)group(44 cases),UA group(65 cases)and healthy group(54 cases).The serum cTnI,CK-MB and CRP levels in 3 groups were detected by adopting the sandwich enzyme-linked immunosorbent method,immunosuppression method and latex-enhanced immunoturbidimetric method respectively,and their positive detection rates were recorded.The UA group underwent coronary angiography(CAG)and according to the Braunwald grading standard at the time of admission,this group was divided into the grade 1 low-risk group(20 cases),gradeⅡmiddle-risk group(23 cases)and gradeⅢhigh-risk group(22 cases).The serum cTnI,CK-MB and CRP levels and positive detection rates were compared among 3 groups,and the relationship between serum cTnI,CK-MB and CRP levels with the myocardial microcirculation status in the UA group was analyzed.Results The serum cTnI,CK-MB and CRP levels and their positive detection rates in the UA group,SA group and healthy group showed a change from high to low presenting the UA group>SA group>healthy group(P<0.05).The pairwise comparison in serum cTnI,CK-MB and CRP levels,their positive detection rates and number of lesion vessels showed no statistical difference among the high risk group,middle risk group and low risk group(P>0.05).The CTFC values in the high risk group,middle risk group and low risk group showed the changes from high to low presenting in the high risk group>middle risk group>low risk group(P<0.05).In the UA group,the ratio of cTnI,CK-MB and CRP positive detection results was significantly higher than that of negative detection results(P<0.05).Conclusion Serum CK-MB and CRP levels in UA patients are higher than those in SA patients and healthy people.Their serum levels up-regulation may predict the poor myocardial microcirculation status.Clinical monitoring of the above indicators has an important diagnostic and differential value for them.