血浆氨基末端脑钠肽前体水平与急性ST段抬高型心肌梗死患者冠状动脉病变程度的关系研究

摘要

目的：探讨血浆氨基末端脑钠肽前体（ NT-proBNP）水平与急性ST段抬高型心肌梗死（ STEMI）患者冠状动脉病变程度的关系。方法选取广西钦州市第二人民医院2012年3月—2015年3月收治的STEMI患者252例，根据血浆NT-proBNP水平分为NT-proBNP正常组（ NT-proBNP <800 ng/L ）126例和NT-proBNP升高组（NT-proBNP>800 ng/L）126例。所用患者入院后进行全面询问病史、体格检查并记录年龄、性别、冠心病家族史、吸烟史及高血压、高脂血症、糖尿病发病情况，入院后24 h内测定血浆NT-proBNP、肌酸激酶同工酶（ CK-MB）、肌红蛋白（ MYO）、超敏肌钙蛋白I（ ultra-TnI）水平，入院第2天清晨采集空腹静脉血检测血脂，采用Judkins法进行冠状动脉造影检查。比较两组患者一般资料、冠状动脉造影结果，并分析血浆NT-proBNP水平与Gensini积分的相关性。结果 NT-proBNP升高组患者高血压发生率、ultra-TnI水平高于NT-proBNP正常组（ P<0.05）。两组患者性别、年龄、高脂血症发生率、糖尿病发生率、冠心病家族史和吸烟史阳性率及CK-MB、MYO、总胆固醇（ TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平比较，差异均无统计学意义（P>0.05）。NT-proBNP升高组冠状动脉三支病变发生率高于NT-proBNP正常组，单支病变、双支/左主干病变发生率低于NT-proBNP正常组（P<0.05）。NT-proBNP升高组患者冠状动脉病变支数多于NT-proBNP正常组，Gensini积分高于NT-proBNP正常组（P<0.05）。直线相关分析结果显示，血浆NT-proBNP水平与Gensini积分呈正相关（r=0.813，P=0.000）。结论血浆NT-proBNP水平与STEMI患者冠状动脉病变程度有关，可通过检测血浆NT-proBNP水平来判断冠状动脉病变程度。%Objective To explore the correlation between serum NT-proBNP level and severity of coronary artery lesions in patients with STEMI. Methods A total of 252 patients with STEMI were selected in the Second People's Hospital of Qinzhou from March 2012 to March 2015 , and they were divided into groups A ( NT-proBNP < 800 ng/L ) and B ( NT-proBNP≥800 ng/L ) according to serum NT-proBNP level, each of 126 cases. Age, gender, family history of coronary heart disease, smoking history, and incidence of hypertension, hyperlipidaemia and diabetes were recorded after admission;serum levels of NT-proBNP,CK-MB,MYO,ultra-TnI were detected within 24 hours after admission;fasting venous blood was collected to detect the blood lipid on the second day morning after admission;Judkins method was used to carry out coronary arteriography;linear correlation analysis was used to analyze the correlation between serum NT-proBNP level and Gensini score. Results The incidence of hypertension,serum ultra-TnI level of B group was statistically significantly higher than that of A group,respectively(P<0. 05);while no statistically significant differences of gender,age,CK-MB,MYO, TC,TG,HDL-C,LDL-C,incidence of hyperlipidaemia or diabetes,positive rate of family history of coronary heart disease or smoking history was found between the two groups ( P >0. 05 ). The incidence of three - vessel lesions of B group was statistically significantly higher than that of B group, while single - vessel and double - vessel lesions ( including left main coronary artery lesions ) of B group were statistically significantly lower than those of A group ( P <0. 05 ). The number of coronary artery lesions of B group was statistically significantly more than that of A group,and Gensini score of B group was statistically significantly higher than that of A group(P<0. 05). Linear correlation analysis showed that,serum NT-proBNP level was positively correlated with Gensini score(r=0. 813,P=0. 000). Conclusion Serum NT-proBNP level is correlated with the severity of coronary artery lesions in patients with STEMI,and the detection of serum NT-proBNP level is helpful to judge the severity of coronary artery lesions.