冠心病心绞痛患者血清hs-CRP和BNP检测的临床意义

Detection of serum hs-CRP and BNP in coronary heart disease patients with angina pectoris and its clinical significance

目的探讨冠心病心绞痛患者血清高敏C-反应蛋白(hs-CRP)和脑型钠尿肽(BNP)的水平与冠状动脉病变的严重程度及心功能的关系。方法入选115例冠状动脉造影阳性心绞痛患者作为冠心病组,40例冠状动脉造影阴性的胸闷症状患者作为对照组。冠心病组根据心绞痛类型进一步分为稳定型心绞痛组(SA组,n=68)和不稳定型心绞痛组(UA组,n=47);根据冠状动脉造影结果分为单支病变组(n=35)、双支病变组(n=38)和三支病变组(n=42),并对冠状动脉进行病变积分。按美国纽约心脏病协会(NYHA)心功能分级标准将心绞痛患者分为心功能Ⅰ级(n=25)、Ⅱ级(n=40)、Ⅲ级(n=35)和Ⅳ级(n=15)。测定各组患者hs-CRP、BNP的水平和左心室射血分数(LVEF)。将BNP分别与冠状动脉病变的支数与积分、NYHA心功能级别、LVEF值进行相关性分析。结果冠心病组血清hs-CRP和BNP水平均显著高于对照组(P<0.05),不稳定型心绞痛患者(UA组)hs-CRP和BNP水平明显高于稳定型心绞痛患者(SA组)(P<0.05);单支病变组hs-CRP和BNP水平较对照组显著升高(P<0.05),双支与三支病变组hs-CRP和BNP水平较单支病变组及对照组显著升高(P<0.05),三支病变组hs-CRP和BNP水平较双支病变组显著升高(P<0.05);BNP水平与冠状动脉病变的支数呈正相关(r=0.65,P<0.05),与冠状动脉病变积分呈正相关(r=0.301,P<0.05);BNP与NYHA心功能级别呈正相关(r=0.78,P<0.05),与LVEF呈负相关(r=-0.56,P<0.05)。随着NYHA分级的增加,血清CRP和BNP水平明显升高(P<0.05)。结论血清hs-CRP和BNP的水平可以作为评价冠心病心绞痛患者冠状动脉病变的严重程度、心绞痛危险分层和心功能分级的辅助指标。

Objective To investigate the relationship between the serum levels of high-sensitivity C-reactive protein（hs-CRP） and brain natriuretic peptide（BNP） and the degree of illness and heart function in the coronary heart disease（CHD） patients positive for angina pectoris.Methods The survey group consisted of 115 angina patients whose CHD diagnosis was confirmed by positive CAG results,with 40 patients of negative CAG results taken to form the control group.In the angina patient survey group,there were 68 cases of stable angina（SA） and 47 cases of unstable angina（UA）,35 patients with single-artery lesion,38 with two-artery lesion and 42 with three-artery lesion.The angina patients were also divided into groups according to the NYHA classification of heart failure.The serum levels of hs-CRP and BNP and the LVEF were measured,the data obtained were analyzed statistically.Results The serum levels of hs-CRP and BNP were significantly higher in the survey group than those in the control group（P〈0.05）.These levels were significantly higher in UA group than in SA group （P〈0.05）,significantly higher in the CHD patients with single-artery lesion than in the control（P〈0.05）,significantly higher in CHD patients with two-artery or three-artery lesion than in those with single-artery lesion（P〈0.05）,higher in the patients with three-artery lesion than in those with two-artery lesion（P〈0.05）.The BNP level was positively correlated with the number of lesion vessels（r=0.65,P〈0.05）,lesion score（r=0.30,P〈0.05） and NYHA classification of heart failure（r=0.78,P〈0.05）.But the BNP level was negatively correlated to LVEF（r=-0.56,P〈0.05）,and the hs-CRP and BNP levels increased with the degree of left ventricle dysfunction（P〈0.05）.Conclusions Serum levels of hs-CRP and BNP can be used as assistant indexes for evaluating degree of CHD,classification of risk,and grade of heart function.