冠心病患者外周血脑钠肽及单核细胞趋化蛋白-1的变化及其临床意义

目的 观察不同类型冠心病患者外周血脑钠肽(BNP)及单核细胞趋化蛋白-1(MCP-1)的水平变化,探讨BNP、MCP-1与冠心病发生、发展的关系. 方法 选择74例人院时初步诊断为冠心病且入院后行冠状动脉造影的患者,其中最后诊断为急性心肌梗死(AMI)20例(AMI组),不稳定型心绞痛(UA)18例(UA组),稳定型心绞痛(SA)19例(SA组),17例经冠状动脉造影证实为无冠心病者作为对照组.采用ELISA法测定各组外周血BNP、MCP-1水平. 结果 (1)AMI组、UA组MCP-1、BNP水平均显著高于SA组和对照组.(2)AMI组BNP水平明显高于UA组,而MCP-1水平与UA组比较差异无统计学意义.(3)AMI组和UA组患者冠状动脉狭窄积分与BNP水平呈正相关(r=0.716,P＜0.01),而与MCP-1水平无相关性,并且BNP水平与MCP-1水平呈正相关(r=0.625,P＜0.01). 结论 冠心病患者外周血BNP、MCP-1水平升高.AMI、UA患者BNP与MCP-1水平升高可能提示斑块不稳定.AMI、UA患者BNP与MCP-1水平明显相关提示两者可能通过不同的方面反映了斑块的不稳定性.联合检测BNP、MCP-1水平,对冠心病患者进行危险分层,能更有效地预测急性冠状动脉事件的发生.

Changes and implication of peripheral blood levels of BNP and MCP-1 in patients with coronary heart disease

Objective To investigate the change of peripheral blood levels of B-type natriuretic peptide(BNP)and monocyte chemoattractant protein-1 (MCP-1)in patients with coronary heart disease,and explore their relationship.Methods Plasma BNP and MCP-1 levels were measured in 20 patients with acute myocardial infarction(AMI group),18 patients with unstable angina(UA group),19 patients with stable angina(SA group)and 17 normal control subjects(control group)by ELISA.Results (1)The levels of BNP,MCP-1 in AMI,UA group were significantly higher than those in SA group and control group.(2)The levels of BNP were significantly different between UA group and AMI group,but the levels of MCP-1 had no significant difference between UA group and AMI group.(3)There was significant correlation between integral of coronary stenosis and BNP level(r=0.716,P＜0.01),and the integral of coronary stenosis had no sisnificant correlation with the level of MCP-1.There was significant correlation between the levels of BNP and MCP-1 in AMI group and UA group(r=0.625,P＜0.01).Conclusions The increased levels of BNP and MCP-1 in patients with coronary heart disease may predict the unstable conditions of plaques.The fact that there is obvious correlation between BNP and MCP-1 suggests that different aspects predict the unstability of plaques.It may be more beneficial in predicting the stability of atherosclerosis plaques and forecasting acute cardiovascular risk by combination detection of serum levels of BNP and MCP-1.