动态心电图缺血性ST段下移与血浆BNP、cTnI、hs-CRP水平变化的临床意义

目的 探讨动态心电图及血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）和高敏C反应蛋白（hs—cRP）水平与冠状动脉狭窄的关系。方法按Braunwald标准，120例心功能正常的不稳定型心绞痛（UAP）患者分为IB组（35例）、ⅡB组（42例）及ⅢB组（43例），并取50例稳定型心绞痛（SAP）患者作为对照组。SAP组与UAP组于入院时及入院后24h抽肘前静脉血2次，分别行BNP、cTnI和hs—CRP检测，取两次结果的最高值。常规行动态心电图检查和择期行冠状动脉造影检查。结果①UAP组缺血性ST。（ST段延续至J点后80ms）段下移水平及BNP、cTnI、hs—CRP均显著高于对照组（P均〈0．05）；ⅢB组显著高于IB组和ⅡB组（P均〈0．05）。②冠脉三支与双支病变组BNP明显高于单支病变组，缺血性sT舶段下移敏感性高于单支病变组。三支病变组BNP、cTnI明显高于双支及单支病变组，组间比较差异有统计学意义（P均〈0．05）。③观察4周，UAP组心脏事件发生率明显高于SAP组（P＜0．05）。Logistic回归分析显示，BNP、cTnI和hs—CRP是30d主要心脏不良事件（MAcE）的独立预测因素。结论动态心电图检查及血浆BNP、cTnI、hs—CRP水平对临床评价UAP患者病情程度及近期预后有重要价值。

The clinical significance of ischemic ST-segment depression Holter monitored and plasma BNP,cTnI and hs-CRP levels

Objective To study the relationship of characteristics of Hoher, plasma BNP, cTnI, hsCRP and coronary artery stenosis in patients with coronary heart disease. Methods According the Braunwald criteria, 120 UAP eases with normal cardiac function were divided into I B group（35 cases）, ⅡB group （42 cases） and ⅢB group （43 cases）, and 50 patients with stable angina pectoris （SAP） patients were enrolled as control group. The plasma levels of BNP, cTnI and hs-CRP were measured in SAP group and the UAP group within 24 h after admission and 24 h after admission and the highest values were taken as results. Routine ECG and elective coronary angiography were undergone then. Results （1）UAP group of ischemic STs0 segment depression levels and BNP, cTn.I, hs-CRP were significantly higher （P〈0.05）. ⅢB group was significantly higher than the I B group and IIB group （P〈0.05）. （2）BNP levels were significantly higher in three and two coronary lesions than single- vessel disease, isehemic ST~ segment depression more sensitive than single-vessel disease group. Levels of BNP and cTnI in 3 lesions was significantly higher than two and one-vessel disease group （P〈0.05）. （3） Observed 4 weeks, UAP group was signi.ficantly higher than cardiac event rate in SAP group （P〈0.05）. Logistic regression analysis showed that BNP, cTnI and hs-CRP in 30 days were independent predictors of MACE. Conclusion ECG and plasma BNP, eTnI, hs-CRP levels are related with the severity of coronary lesions in patients with UAP and show prognostic value in MACE.