急性冠脉综合征患者NT-proBNP、超敏C反应蛋白及心肌酶学相关研究

目的探讨不同类型冠状动脉粥样硬化性心脏病（冠心病）患者血清N端脑钠肽前体（NT-proB-NP）、超敏C反应蛋白（hs-CRP）、肌酸激酶同工酶（CK-MB）及心肌肌钙蛋白I（cTnI）水平及意义。方法选择急性冠脉综合征（ACS）患者136例,其中不稳定心绞痛（UAP）31例、ST段抬高型急性心肌梗死（STEMI）71例及非ST段抬高型急性心肌梗死（NSTEMI）34例;同期冠状动脉造影（CAG）阴性患者27例作为对照组。所有入选对象均检测NT-proBNP、hs-CRP、CK-MB及cTnI并进行分析。结果 ACS综合征组血浆NT-proBNP、hs-CRP、CK-MB和cTnI水平均较对照组增高,且由对照组、UAP组、NSTEMI组及STEMI组依次呈现增高趋势,各组均数比较,差异有显著统计学意义（P均〈0.01）。NT-proBNP与hs-CRP存在正相关（r=0.553,P〈0.01）。结论 ACS患者血浆NT-proBNP、hs-CRP联合检测可作为传统的心肌酶谱检测的补充,对评价ACS严重程度有一定的临床意义。

Levels of NT-proBNP,hypersensitivity C-reactive protein and myocardial enzyme in patients with acute coronary syndrome

Objective To investigate the changes of N-terminal pro-brain natriuretic peptide （NT-proBNP）,high sensitive C-reaction protein （hs-CRP）,creatine kinase-MB （CK-MB） and cardiac troponin I（cTnI）in the patients with different types of coronary heart disease （CHD）,and explore the clinical significance.Methods The patients with acute coronary syndrome （ACS,n=136,ACS group） diagnosed definitely by coronary angiography （CAG） and hospitalized in the Affiliated Hospital of Medical College of Qingdao University from Jan.2007 to Feb.2010.Among them there were 31 cases of unstable angina pectoris （UAP）,71 of ST-elevation acute myocardial infarction （STEMI） and 34 of non-STEMI.Other 27 patients with negative CAG were enclosed into the control group.The ACS patients were divided again into the single-vessel group （n=36）,double-vessel group （n=47） and triple-vessel group （n=53） according to the outcomes of CAG.The changes of CK-MB,cTnI,hs-CRP and NT-proBNP were detected and analysed in all subjects.Results ①The levels of hs-CRP and NT-proBNP increased significantly in the ACS group compared with those in the control group （P0.01 or P0.05）,and the difference among all ACS groups was statistically significant.The levels of hs-CRP and NT-proBNP were higher in the triple-vessel group than those in the double-vessel group and single-vessel group.②The levels of cTnI and CK-MB increased in the ACS group compared with those in the control group （P0.01 or P0.05）,but there was no difference among all ACS groups.Conclusion The simultaneous detection of serum NT-proBNP and hs-CRP can provide a forcible supplement for traditional myocardial enzymogram detection,which is important to the severity evaluation and risk stratification of ACS.