急性冠脉综合征患者血清NT-proBNP、hs-CRP、FBG及Leptin的临床研究

目的 测定急性冠脉综合征（ACS）患者、稳定型心绞痛（SAP）患者及健康人血清N末端B型钠尿肽前体（NT-proBNP）、超敏C-反应蛋白（hs-CRP）、空腹血糖（FBG）及瘦素（Leptin）水平的变化,并探讨其变化的临床意义.方法 选取急性心肌梗死（AMI）患者30例,不稳定型心绞痛（UAP）患者30例,稳定型心绞痛（SAP）患者30例,并选取与之年龄、性别相匹配的30名同期到我院的健康体检者作为正常对照组.测定所有入选对象的血清NT-proBNP、hs-CRP、FBG及Leptin的浓度;对所有入选对象行心脏超声心动图检查,测定左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）.结果 ①AMI组血清NT-proBNP浓度明显高于UAP组、SAP组及正常对照组,差异均有统计学意义（P＝0.025,P＝0.000,P＝0.000）.UAP组NT-proBNP浓度明显高于SAP组及正常对照组,差异有统计学意义（P＝0.029,P＝0.008）.SAP组NT-proBNP浓度高于正常对照组,差异有统计学意义（P＝0.000）.②AMI组血清hs-CRP浓度与UAP组相比,差异无统计学意义（P＝0.869）,与SAP组及正常对照组相比,差异均有统计学意义（P＝0.000,P＝0.000）.UAP组hs-CRP浓度明显高于SAP组及正常对照组,差异均有统计学意义（P＝0.000,P＝0.000）.③AMI组血清FBG浓度明显高于UAP组、SAP组及正常对照组,差异有统计学意义（P＝0.049,P＝0.000,P＝0.000）.UAP组FBG浓度明显高于SAP组及正常对照组,差异有统计学意义（P＝0.001,P＝0.003）.④AMI组血清Leptin浓度与SAP组及正常对照组相比,差异均有统计学意义（P＝0.001,P＝0.000）.UAP组Leptin浓度明显高于SAP组及正常对照组,差异均有统计学意义（P＝0.041,P＝0.000）;SAP组与正常对照组相比,差异有统计学意义（P＝0.000）.⑤AMI组LVEF值与UAP组相比,差异无统计学意义（P＝0.104）,明显低于SAP组及正常对照组（P＝0.000,P＝0.000）.UAP组LVEF值明显低于SAP组及正常对照组,差异均有统计学意义（P＝0.000,P＝0.000）,SAP组明显低于正常对照组,差异有统计学意义（P＝0.000）.结论 ①ACS患者发病早期往往伴有NT-proBNP、hs-CRP、FBG及Leptin水平升高.②ACS患者多伴有心室重塑,往往有LVEDD增大及LVEF值下降.

The association of N-terminal pro-brain natriuretic peptide (NT-proBNP),fasting blood glucose(FBG), highsensitive c-reactive protein(hs-CRP) and leptin in patients with acute coronary syndorme(ACS)

Objective This study addressed to measure serum N-terminal pro-brain natriuretic peptide （NT-proBNP）, fasting blood glucose （FBG）, highsensitive c-reactive protein （hs-CRP） and leptin concentration in patients with acute coronary syndorme, stable angina pectoris and normal healthy subjeets, and aims to investigate the eorrelation among them, and the clinical signifieance. Methods One hundred and twenty subjects were divided into four groups： 30 patients with acute myocardial infarction, 30 patients with unstable angina pectoris, 30 patients with stable angina pectoris and 30 normal healthy subjects who were matehed with age and sex as con- trol. NT-proBNP, FBG, hs-CRP and leptin＇s concentration were determined by Biochemistry Laboratory, all the suhjeets were performed to detect left ventricular ejection fraction, left ventrieular diastolic diameter by echoear- diography. According to the levels of the NT-proBNP coneentration, ACS patients were divided into two groups to observe the relationship between the levels of the NT-proBNP and prognosis. Results （1）The serum level of NT- proBNP was higher in AMI patients than those of UAP, and AP, and eontrol subjects （P=0.025, P=0.000, P= 0.000）. The serum level of NT-proBNP in UAP patients was higher than SAP, eontrol subjeets （P=O.O29,P= 0.008）. SAP patients＇ level was higher than normal healthy subjects （P=0.000）. （2）Compared with AMI patients, the level of hs-CRP in UAP patients has no signifieant difference（P=0.869）, but the level of hs-CRP in AMI and UAP patients was increased than SAP and normal subjects （P=0.000,P=0.000）. （3）The serum level of FBG was higher in AMI patients than those of UAP, and SAP, and control subjeets （P=0.049, P=0.000, P=0.000）. The serum level of FBG in UAP patients was higher than SAP, control subjeets（P=0.001,P=0.003）. （4）Compared with AMI patients, the level of leptin in UAP patients has no significant difference （P=0.105）, but the level of leptin in AMI patients was increased than SAP and normal subjects （P=0.000,P=0.001）. The serum level of leptin in UAP patients was higher than SAP, and control subjeets（P--0.041 ,P=0.000）, the level of leptin in SAP and nor- real patients has also significant difference （P=0.O00）. （5）The level of LVEF in AMI and UAP has no significant difference （P=0.104）, but the level of LVEF in AMI and UAP patients was decreased than SAP and normal sub- jects（P=0.000,P=0.000）, the level of LVEF in SAP and normal patients has also significant difference, too（P= 0.000）. Conclusion The levels of NT-proBNP were negative correlated with LVEF, were positive correlated with LVDD and hs-CRP, hs-CRP was positive and significantly correlated with NT-proBNP, FBG was positive and significantly correlated with NT-proBNP and Leptin, and LVEDD was negative and signifleantly correlated with LVEF.