冠心病患者高敏C反应蛋白和NT-proBNP水平的变化

摘要

目的 观察冠心病(CHD)患者高敏C反应蛋白(hs-CRP)含量变化并探讨其与CHD不同类型及心功能的关系.方法 选择经冠状动脉造影确诊的CHD患者894例,健康对照者141名,用微粒子增强透射免疫分析法测定其血清hs-CRP水平,并进行对比分析.结果 CHD患者组血清hs-CRP水平中位数为1.70(0.13～19.53)mg/L,异常率为37.6%(336/894),均显著高于健康对照组的0.99(0.13～19.53)mg/L和7.1%(10/141),差异有统计学意义(Z=-6.476,X<'2>=50.882,P均<0.01);且急性心肌梗死组血清ha-CRP水平中位数为5.35(0.18～19.10)mg/L、异常率为63.9%(92/144),高于陈旧性心肌梗死组的2.27(0.13～19.19)mg/L和43.7%(129/295),差异有统计学意义(Z=-3.353,X<'2>=15.732,P均<0.01);不稳定型心绞痛组血清hs-CRP水平中位数为1.45(0.19～19.53)ms/L、异常率为29.1%(73/251),高于稳定型心绞痛组的1.04(0.13～16.31)mg/L和20.6%(42/204),差异有统计学意义(Z=-2.981,P=0.003;X<'2>=4.30,P=0.038).Kruskal-Wallis检验显示CHD患者hs-CRP和NT-proBNP浓度都随着心功能障碍程度加重(NYHA心功能分级升高)而渐增,组间差异均有统计学意义(X<'2>=120.185、424.945,P均<0.01);多因素相关分析表明血清hs-CRP水平与NT-proBNP浓度(r=0.413,P<0.01)和美国纽约心脏病协会(NYHA)心功能分级(r=0.328,P<0.01)之间具有正相关性.结论 血清hs-CliP水平随CHD类型和心功能障碍程度的不同而变化,说明hs-CRP可能在CHD的发生发展中起一定作用.%Objective To investigate plasma levels of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary heart disease (CHD) and relationship between hs-CRP levels and cardiac function. Methods The serum hs-CRP concentrations in 894 CHD patients diagnosed by coronary angiography and 141 healthy controls were measured by particle enhanced immunoturbidimetric assay. Results The median of hs-CRP levels was 1.70 (0.13-19.53 ) mg/L and abnormal ratio was 37.6% (336/894), that were significantly higher in CHD group than healthy controls [0. 99(0. 13-19. 53) rag/L, 7. 1% (10/141) ] (Z=-6. 476,X<'2> = 50. 882, P <0.01 ). The median of hs-CRP levels was 5.35 (0. 18-19. 10) mg/L and abnormal ratio was 63.9% (92/144), that were much higher in acute myocardial infarction (AMI) group than in old myocardial infarction (OMI) group [2.27 (0.13-19.19) mg/L, 43.7% (129/295) ] (Z = -3.353 ,X<'2> = 15. 732, P <0. 01 ). The median of hs-CRP levels was 1.45 (0.19-19.53) mg/L in unstable angina pectoris(UAP) group and abnormal ratio was 29.1% (73/251), that were was higher in stable angina pectoris (SAP) group [1.04 (0.13-16.31 ) mg/L, 20. 6% (42/204) ] (Z=-2.981, P = 0.003;X<'2> = 4.30, P=0.038 ) . Furthermore, Kruskal-Wallis test showed the concentrations of hs-CRP and NT-proBNP was increased along with increment of CHD severity (NYHA functional classification) (X<'2> = 120.185,424.945, P <0.001 ). Multivariate analysis showed that hs-CRP levels positively correlated with NYHA functional classification ( r = 0.328, P <0.01 ) as well as NT-proBNP levels (r=0.413, P <0.01 ). Conclusion Serum hs-CRP level increases along with CHD severity, indicating that hs-CRP may play a certain role in the occurrence and development of CHD.