急性冠脉综合征患者血清C-反应蛋白、脑利尿钠肽、D-二聚体水平变化与临床意义

Serum CRP,BNP,D-dimer level changes and clinical significance of acute coronary syndrome

目的探讨血清C-反应蛋白（CRP）、脑利尿钠肽（BNP）和D-二聚体（D—D）的水平变化在急性冠脉综合征（ACS）的临床应用及评价。方法选取2010年1～12月永州市中心医院120例经冠状动脉造影证实的ACS患者，分为不稳定型心绞痛（UAP）组62例，急性心肌梗死（AMI）组58例，另选取经冠状动脉造影的稳定型心绞痛（SAP）组50例及健康对照组42例。对比分析各组CRP、BNP、D—D水平。170例冠心病患者依据冠脉不同病变支数分为单支组（n=86）、双支组（n=48）及3支组（n：36），对比分析各组CRP、BNP、D—D水平。170例冠心病患者进行心功能分组，对比分析各组CRP、BNP、D—D水平。结果AMI组CRP、BNP、D—D水平明显高于UAP组，两组均高于SAP组，差异有高度统计学意义（P〈0．01）。3支组CRP、BNP、D—D水平明显高于双支组，双支组也明显高于单支组（P〈0．01）。AMI、UAP、SAP患者心功能异常组的BNP、D—D水平显著高于正常组（P〈0．01）。结论联合检测血浆CRP、BNP、D-D水平不仅能评价心功能受损程度，而且有助于早期发现ACS、冠脉病变严重程度的判断及预后判断。

Objective To investigate the serum C-reactive protein （CRP）, brain natriuretic peptide （BNP） and D-dimer （DD） levels of acute coronary syndrome （ACS） clinical application and evaluation. Metheds 120 patients with ACS were confirmed by coronary angiography, divided into unstable angina pectoris （UAP） group of 62 patients＇ with acute myocardial infarction （AMI） group of 58 cases, also selected stable angina peetoris （SAP） group of the 50 cases confirmed by coronary angiography and 42 healthy control group. The comparative analysis of each group CRP, BNP, D-D level, 170 cases of coronary heart disease patients were divided into single-vessel group （n = 86）, double vessels group （n = 48） and three vessels group （n = 36） based on different coronary lesion count, comparative analysis of each group CRP, BNP, DD level were compared. 170 cases of coronary heart disease patients combined echocardiographic indices of cardiac function group, comparative analysis of cardiac function in normal and abnormal group CRP, BNP, DD level were compared. Results CRP, BNP, DD levels in AMI group was significantly higher than the UAP group, the two groups were higher than SAP （P 〈 0.01）. The CRP, BNP, DD levels significantly in the three vessels group higher than the group of double vessels the double groups＂ also significantly higher than that of single-vessel group （P 〈 0.01）. AMI, UAP, SAP cardiac functional class II BNP, DD levels were significantly higher grade I （P 〈 0.01）. Conclusion Plasma CRP, BNP, DD joint detection is not only able to evaluate the degree of impaired cardiac function, but also contribute to the early detection of ACS, the judgment of the severity of coronary lesions and prognosis.