不同类型冠心病患者血浆B型利钠肽和纤维蛋白原变化及其意义

Study on the levels of plasma B-type natriuretic peptide and fibrinogen and their significance among different clinical phenotypes of coronary heart disease.

目的观察不同临床类型冠心病患者血浆B型利钠肽（BNP）、纤维蛋白原（FIB）浓度的差异及其临床意义。方法经冠状动脉造影证实的冠心病患者100例，按临床类型分为急性心肌梗死（AMI）45例，不稳定型心绞痛（UAP）29例，稳定型心绞痛（SAP）26例。20例非冠心病者作为对照组。检测AMI患者发病16～20h以及其他研究对象入院时的血浆BNP浓度，同时测定所有患者FIB浓度。比较各组间BNP、FIB的差异。结果①AMI组平均BNP明显高于UAP组、SAP组和对照组（t值分别为5．233、10．133、11．800，P均〈0．01），UAP组平均BNP明显高于SAP组和对照组（t值分别为4．809、5．884，P均〈0．01），SAP组高于对照组（t值为2．830，P〈0．05）。多支病变组平均BNP高于单支和0支病变组（t值分别为10．262、15．366，P均〈0．01）。②AMI组平均nB明显高于UAP组、SAP组和对照组（t值分别为3．871、5．403、6．505，P均〈0．01），UAP组平均FIB明显高于对照组（t值为2．720，P〈0．05），SAP组和对照组FIB无明显差异（t值为1．211，P〉0．05）。多支病变组平均FIB高于单支和0支病变组（t值分别为4．983、6．364，P均〈0．01）。结论不同临床类型冠心病患者的血浆BNP、FIB浓度存在差异，其水平高低与冠心病的病变范围关系密切。

Objective To explore the differences of levels of B-type natriuretic peptide（BNP） and fibrinogen（FIB） and clinical phenotypes of coronary heart disease （CHD）. Methods 100 patients with CHD were enrolled in this study, including 45 patients with acute myocardial infarction （AMI）, 29 patients with unstable angina pectoris （UAP）, and 26 patients with stable angina pectoris （SAP） ;20 subjects without CHD were taken as controls. Plasma levels of BNP as well as FIB were detected at 16 to 20 hours after the appearance of symptoms in AMI group or on admission in other groups. Results （1）BNP was higher,in AMI group than in other three groups （P 〈 0.01 ）, in UAP group than in SAP and control group（ P 〈 0. 01 ） ,in SAP group than in control group（ P 〈 0. 05） ,in patients who had complex lesions compared with those who had simple or no lesions （ P 〈 0. 01 ） ; （2）FIB was higher, in AMI group than in other three groups （ P 〈 0. 01 ）, higher in UAP group than in control group （ P 〈 0.05 ）, higher in patients who had complex lesions than in those who had simple or no lesions （ P 〈 0.01 ）. Conclusion Plasma levels of BNP and FIB are closely associated with clinical phenotypes of CHD and differences exist between their levels.