冠心病患者血清同型半胱氨酸和N端前体脑钠肽检测及意义

Detection and significance of serum homocysteine and NT-proBNP in patients with coronary heart disease

目的探讨联合检测同型半胱氨酸(Hcy)和N末端前体脑钠肽(NT-proBNP)对冠心病病情评估和预后判断的临床指导意义。方法收集经冠状动脉造影确诊为冠心病的门、急诊及住院患者血清标本检测Hcy及NT-proBNP浓度。根据患者病情及冠状动脉病变支数分组进行统计分析。对照组为排除心血管疾病的体检者标本。结果急性心肌梗死(AMI)组、不稳定型心绞痛(UA)组和稳定型心绞痛(SA)组血清NT-proBNP、Hcy均高于对照组。三组间比较,血清NT-proBNP、Hcy增高依次为AMI组大于UA组大于SA组,差异有统计学意义;且冠状动脉病变支数的增加及血清NT-proBNP水平的升高,三组间差异也有统计学意义;而Hcy水平变化不大,差异无统计学意义。结论冠心病患者血清Hcy水平可对冠状动脉粥样硬化的程度进行一定的评估,而NT-proB-NP水平可直接反映心肌有无缺血及缺血程度。二者联合检测可对冠心病的病情作出客观评价,以便及早采取干预措施,降低发生心血管事件的风险。

Objective To explore the clinical guiding significance of combination detection of serum homocysteine （Hey） and N terminal pro--brain natriuretic peptide（NT-proBNP） for assessing and judging the disease condition and prognosis of coronary heart disease（CHD）. Methods The serum samples of coronary artery disease patients from emergency cases,outpatients and inpatients diagnosed by coronary artery angiography were collected and detected the concentration of Hcy and NT proBNP. All the results were grouped according to the disease condition and the number of ill coronary vessels and statistically analyzed. The control group were the samples of physical examination, in which cardiovascular diseases were excluded. Results Serum Hcy and NT proBNP in the acute myocardial infarc tion（AMI） group,unstable angina（UA） group and stable angina（SA） group were higher than those in the control group. In comparison among three groups, the increases of NT-proBNP were in turn AMI group〉 UA group〉 SA group,with statistical differences. Serum NT-proBNP rise and in coronary vessels increase also had statistical differ ence. But serum Hey levels were changed rarely without statistical difference. Conclusion Serum Hcy level could be used to estimate the extent of atherosclerosis in the patients with CHD. And serum NT proBNP level can directly reflect wether the myocardial ischemia happens and its extent. Their combination detection can help to make an objective evaluation about the condition of CHD in order to take intervention as soon as possible for reducing the risk of cardiovascular events.