总胆固醇正常的冠心病患者心肌缺血预警指标的临床研究

Clinical studies on early warning indices for myocardial ischemia by coronary patients with normal total cholesterol

目的探讨高敏C-反应蛋白(hs-CRP)和心型脂肪酸结合蛋白(h-FABP)对总胆固醇正常的冠心病(CHD)患者心肌缺血的预警作用。方法将住院的总胆固醇正常的CHD患者分成稳定型、不稳定型心绞痛和急性心肌梗死三组。其中,稳定型心绞痛(SAP)住院患者63例,男39例,女24例;同期住院的不稳定型心绞痛(UAP)患者58例,男31例,女27例;急性心肌梗死患者23例,男14例,女9例。分别检测其血清hs-CRP、h-FABP、cTn-I和CK-MB的含量。同时,抽取同期门诊47例健康体检者作为对照组。结果SAP和UAP组患者血清hs-CRP的含量分别为(1.63±0.53)mg/L和(6.34±1.97)mg/L,高于对照组的(0.71±0.32)mg/L(P<0.05,P<0.01)。SAP和UAP组患者血清h-FABP的含量分别为(2.89±0.76)μg/L和(17.14±5.69)μg/L,高于对照组的(1.76±0.68)μg/L(P<0.05,P<0.01)。结论hs-CRP、h-FABP联合检测与传统心肌损伤检测指标cTn-I、CK-MB相比,对总胆固醇正常的CHD患者发生心肌缺血的可能性具有更高的预测价值。

Objective Probing early warning effects of high-sensitivity C-reaction protein （hs-CRP） and heart fatty acid binding protein （h-FABP） on myocardial ischemia by coronary patients with normal total cholesterol. Methods Inpatients with coronary heart disease （CHD） whose total cholesterol was normal were divided into 3 groups of stable angina pectoris （SAP）, unstable angina pectoris （UAP） and acute myocardial infarction （AMI）. Among the patients, there were 63 patients （male 39 and female 24） in SAP while there were 58 patients （male 31 and female 27） in UAP, and 23 patients （male 14 and female 9） in AMI during the same period. All the inpatients＇ levels of serum hs-CRP, h-FABP, cardiac troponin-I （cTn-I） and creatine kinase MB isoenzyme （CK-MB） were tested respectively. In the meantime, homochronous 47 healthy outpatients who had medical check-up were chosen as control. Results The serum hs-CRP content for SAP and UAP patients was （1.63±0.53）mg/L and （6.34±l.97）mg/L respectively, which were higher than （0.71±0.32）mg/L for the control group, with the inter-group difference having an important significance （P〈0.05） or an extremely important significance （P〈0.01）. The serum h-FABP content for SAP and UAP patients was （2.89±0.76）μg/L and （17.14±5.69）μg/L respectively, which were higher than （1.76±0.68）μg/L for the control group, with the inter-group difference having an important significance（P〈0.05 ） or an extremely important significance （P〈0.01）. Conclusions In comparison with cTn-I and CK-MB, traditional test indices for myocardial damages, combined tests on hs-CRP and h-FABP are of more important values in predicting the likelihood of myocardial ischemia for CHD patients with normal total cholesterol.