血浆同型半胱氨酸、B型钠尿肽联合检测在冠心病中的应用评价

发布时间：2018-07-20 12:36

【摘要】：目的:探讨血浆同型半胱氨酸和B型钠尿肽联合检测在冠心病(CHD)中的应用评价。方法:选择2011-09至2012-09期间在唐山工人医院心内科住院的冠心病患者475例(入院的患者均符合冠心病临床诊断且冠脉造影结果阳性),按累及血管支数分为单支病变组(224例)、双支病变组(160例)、三支病变组(91例),左主干病变列为双支病变。所有患者依照临床分型分为:不稳定型心绞痛组(171例),其中男98例,女73例,年龄36岁~72岁(51.0岁±8.7岁);急性心肌梗死组(185例),其中男100例,女85例,年龄45岁~76岁(57.0岁±13.2岁);稳定型心绞痛组(119例),其中男68例,女51例,年龄42岁~75岁(54.0岁±16.7岁)。同时选取无冠心病病史且冠脉造影阴性者138例作为对照组,男性71例,女性67例,年龄40~60岁,平均(52.36±5.52)岁。冠心病组与对照组均为居住于唐山地区的汉族人,无血缘关系,详细询问患者的吸烟史、高血压病史、糖尿病病史、高胆固醇病史等相关冠心病危险因素,排除了脑血管疾病、慢性肾功能不全、慢性肝功能不全、心力衰竭、肺部疾病、肿瘤或相关药物等影响Hcy及BNP的升高的相关因素。研究个体之间不重复,入选患者冠状动脉造影及采血前获取知情同意。患者冠脉造影前测定各组血浆同型半胱氨酸(Hcy)及B型钠尿肽(BNP)浓度。冠脉造影后采用Gensini评分系统评定冠状动脉狭窄程度。比较冠心病组与对照组及冠心病各组间的Hcy及BNP水平,并将BNP水平与各组Gensini评分及冠脉病变程度作相关性分析。冠心病组患者随访1年,记录主要心血管不良事件,同时分析冠心病不同组别Hcy、BNP与发生心血管不良事件的关系。采用SPSS13.0统计软件进行统计学分析,相关性用相关分析,计数资料比较用χ2检验,P0.05具有统计学意义。结果:AMI、UAP组、SAP组及对照组血浆Hcy分别为27.38±13.67mmol/L、19.34±13.19mmol/L、13.59±3.84mmol/L、8.82±2.23mmol/L;以上四组血浆BNP分别为152.59±57.78pg/ml、89.34±26.67pg/ml、55.40±20.21pg/ml、41.68±8.16pg/ml,冠心病组水平均明显高于正常对照组,且冠心病组组间比较显示急性心肌梗死组不稳定型心绞痛组稳定性心绞痛组(P0.05),差异有统计学意义。冠心病组中(Hcy及BNP水平)三支病变组二支病变组一支病变组(P0.05),随着冠状动脉病变类型严重程度的增加,Hcy、BNP明显增高。血浆BNP水平与冠状动脉病变支数、评分之间呈正相关,相关系数分别为r1=0.251、r2=0.554。对冠心病组患者随访1年发现,475例患者中发生心血管事件的有32例(6.7%),发生者Hcy及BNP水平高于未发生心血管事件的患者。结论:冠心病患者血浆Hcy、BNP水平高于正常人群,且Hcy、BNP水平随冠状动脉受累数目的增多而升高,它作为筛查心血管疾病良好的生化指标,对冠心病的早期诊断和治疗具有重要意义。
[Abstract]:Objective: to evaluate the application of plasma homocysteine and B type natriuretic peptide in coronary heart disease (CHD). Methods: 475 patients with coronary heart disease (CHD) hospitalized in Department of Cardiology, Tangshan Workers' Hospital from September 2011 to September 2012 were selected (all the patients were in accordance with the clinical diagnosis of coronary heart disease and the results of coronary angiography were positive). The patients were divided into single vessel lesion group according to the number of branches involved. (224 cases), double vessel lesion group (160 cases), three vessel lesion group (91 cases), left main artery disease was classified as double vessel disease. According to the clinical classification, all the patients were divided into unstable angina pectoris group (171 cases), male 98 cases, female 73 cases, age 36 years 72 years (51.0 卤8.7 years), acute myocardial infarction group (185 cases), male 100 cases, female 85 cases, acute myocardial infarction group (185 cases). The patients were 45 years old and 76 years old (57.0 卤13.2 years old) and stable angina pectoris group (119 cases), including 68 males and 51 females, aged 42 years and 75 years (54.0 卤16.7 years). 138 patients with no history of coronary heart disease and negative coronary angiography were selected as control group. There were 71 males and 67 females with an average age of (52.36 卤5.52) years. The coronary heart disease group and the control group were both Han people living in Tangshan area. There was no blood relationship. The risk factors of coronary heart disease such as smoking history, hypertension history, diabetes history, hypercholesterolemia history and so on were asked in detail, and cerebrovascular diseases were excluded. Chronic renal insufficiency, chronic liver insufficiency, heart failure, lung disease, tumor or related drugs and other related factors affecting the increase of Hcy and BNP. There was no duplication between individuals, and informed consent was obtained before coronary angiography and blood sampling. Plasma homocysteine (Hcy) and type B natriuretic peptide (BNP) were measured before coronary angiography. The degree of coronary artery stenosis was evaluated by Gensini scoring system after coronary angiography. The levels of Hcy and BNP were compared between coronary heart disease group and control group, and the correlation between BNP level and Gensini score and severity of coronary artery disease was analyzed. The patients in coronary heart disease group were followed up for one year to record the main adverse cardiovascular events and to analyze the relationship between Hcyn BNP and cardiovascular adverse events in different groups of coronary heart disease. SPSS 13.0 statistical software was used for statistical analysis, correlation analysis was used for correlation analysis, and 蠂 2 test was used to compare the count data (P0.05) with statistical significance. Results the plasma Hcy levels in SAP group and control group were 27.38 卤13.67 mmol / L 19.34 卤13.19 mmol / L and 8.82 卤2.23 mmol / L, respectively, and those in the above four groups were 152.59 卤57.78 mg / ml, 89.34 卤26.67 PG / ml, 55.40 卤20.21 mg / L and 41.68 卤8.16 mmol / L, respectively. The levels of plasma Hcy in CHD group were significantly higher than those in normal control group. And coronary heart disease group comparison showed that acute myocardial infarction group unstable angina pectoris group (P0.05), the difference was statistically significant. In the coronary heart disease group (Hcy and BNP levels), the level of Hcy and BNP in the three-vessel lesion group was significantly increased with the increase of the severity of coronary artery disease type (P0.05). The plasma BNP level was positively correlated with the number and score of coronary artery lesion, and the correlation coefficient was 0.251g / r _ 2 and 0.554respectively. 32 (6.7%) of 475 patients in coronary heart disease group were followed up for one year. The levels of Hcy and BNP were higher in patients with coronary heart disease than those without cardiovascular events. Conclusion: the plasma level of Hcyn BNP in patients with coronary heart disease is higher than that in normal subjects, and the level of Hcyn BNP increases with the increase of the number of coronary artery involvement. As a good biochemical index for screening cardiovascular disease, it is of great significance for the early diagnosis and treatment of coronary heart disease.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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