急性冠状动脉综合征患者脑钠肽及高敏C反应蛋白与脂蛋白水平的相关研究

目的 探讨血清脑钠肽(BNP)与急性冠状动脉综合征之间的相关性及可能的临床意义.方法 研究对象为急性心肌梗死患者36例(AMI组),不稳定型心绞痛患者38例(UAP组),稳定型心绞痛患者30例(SAP组),健康体检者30例(对照组).用酶联免疫吸附分析法测定所有研究对象的血清BNP、hs-CRP和Lp(a)浓度,并行心脏超声检查,测定左心室射血分数(LVEF)、左心室收缩末期容积(LVEDV)及舒张末期容积( LVESV).结果 AMI组的BNP、hs-CRP、Lp(a)水平分别为(391±136) ng/L、( 16±15) mg/L、(367±191 )mg/L.UAP组分别为(267±80) ng/L、(11±7) mg/L、(324±171) mg/L.SAP组分别为(36±21) ng/L、(2±1)mg/L、(191±130) mg/L.对照组分别为(33±14) ng/L、(1.0±0.4)mg/L、(150±116)mg/L.AMI组和UAP组上述指标与对照组及SAP相比,差异有统计学意义(P＜0.05或P＜0.01).AMI组与SAP组上述指标比较,差异有统计学意义(均P ＜0.05).AMI组与UAP组比较,差异无统计学意义(均P＞0.05).AMI组LVEDV、LVESV、LVEF分别为(95±19)、(43±9)ml,(0.51±0.08)；UAP组分别为(93±23)、(42±8)ml,(0.55 ±0.08)；AP组分别为(86±18)、(32±9)ml,(0.64±0.09)；对照组分别为(86±18)、(29±9)ml,(0.66±0.09).AMI组、UAP组与SAP组及对照组比较,差异均有统计学意义(P＜0.01).AMI组与UAP组比较,差异无统计学意义(P＞0.05).SAP组与对照组比较,差异无统计学意义(P＞0.05).多元回归分析表明,在ACS患者中,BNP浓度与hs-CRP和Lp(a)呈正相关,(r=0.53,P＜0.01;r=0.543,P＜0.01).BNP浓度与LVEF明显负相关(r=-0.44,P＜0.01).控制年龄、性别、体表面积后计算两变量间偏相关系数.急性冠状动脉综合征患者首次发病48 h内BNP浓度与同期测定的左心室舒张末容积、收缩末 容积呈正相关(r =0.42、0.40,均P＜0.01).结论 血清BNP浓度在ACS患者中明显升高,可作为重要的诊断指标之一.ACS患者BNP浓度的升高除了与心脏大小和射血分数相关外,也可能与缺血损伤造成的急性期炎症反应有关.

The association among brain natriuretic peptide, high sensitive c-reative protein and leptein (a) in patient with acute coronary syndrome

Objective To measure serum B-type natriuretic peptide (BNP),high-sensitive C-reactive protein( hs-CRP)and leptein (a) concentration in patients with acute coronary syndrome,stable angina pectoris and normal healthy subjects ; to investigate the correlation of between BNP and acute coronary syndrome.Methods One hundred and ninety subjects were divided into four groups: 36 patients with acute myocardial infarction (AMI group),38 patients with unstable angina pectoris(UAPgroup) ; 30 patients with stable angina pectoris( SAP group)and 30 normal healthy subjects as the control group.Serum BNP concentration was determined by enzyme linked immuno-asorbent assay Echocardiography was performed in all patients with coronary artery disease to detect left ventricular ejection fraction (LEVF),left ventricular volume parameters and to evaluate ventricular wall-motion.Results The level of serum BNP concentration was high in patients with AMI group (391 ± 136)ng/l and UAPgroup (267 ±80)ng/l than that with SAP group (36 ±21 )mg/L and control group ( 1.0 ±0.4) mg/L,P ＜0.05,respectively.The level of serum concentration hs-CRP was higher in patients with AMI group ( 16 ± 15 ) mg/L and UAPgroup ( 11 ± 7 ) mg/L than that with SAP group (2 ± 1 ) mg/L and control group ( 1.0 ± 0.4 ) mg/L,P ＜ 0.05.The serum level of Lp(a) was higher in UAPgroup (324 ± 171 )mg/L and AMI group (367 ± 191 ) mg/L patients than that in SAP group ( 191 ± 130 ) mg/L patients and control group patients ( 150 ± 116 ) mg/L ( P ＜ 0.01 ).Serum BNP concentration was positively correlated with hs-CRP and Lp(a) (r =0.53,0.54 P ＜0.01 ) and negatively correlated with LVEF.Conclusion The reason of increased serum BNP concentration is not only corrected with the LVEF,but also with the reaction of acute inflamation due to coronary ischemia.