血浆同型半胱氨酸与N末端B型利钠肽原联合检测对冠心病患者的临床预测价值

The predictive value of the combination of homocysteine and NT-proBNP on assessment of patients with coronary heart disease

目的 分析血浆同型半胱氨酸（Hcy）与N末端B型利钠肽原（NT-proBNP）联合检测对预测冠心病患者冠状动脉（冠脉）病变及预后的临床价值.方法 选择我院就诊的204例冠心病患者为研究对象,按照临床诊断分为：急性心肌梗死（AMI）组68例,不稳定性心绞痛（UAP）组72例,稳定性心绞痛（SAP）组64例.并选择同期正常健康体检者70例为对照组.检测并比较4组对象Hcy及NT-proBNP水平的差异.根据冠脉造影结果计算并比较3组患者的Gensini积分,随访6个月比较3组患者发生主要不良心脏事件的差异.分析Hcy与NT-proBNP水平与Gensini积分及主要不良心脏事件发生率的相关性.结果 4组Hcy与NT-proBNP浓度以及Gensini评分、主要不良心脏事件发生率比较,差异均有统计学意义（P＜0.05）,且均为AMI组＞UAP组＞SAP组＞对照组（P值均＜0.05）;Hcy与NT-proBNP水平与Gensini积分存在相关性,且与主要不良心脏事件发生率有相关性（P值均＜0.05）.结论 Hcy与NT-proBNP联合检测能反映冠心病患者的冠脉病变程度及有效预测预后.

Objective To analyze the predictive value of the combination of homocysteine（Hcy） and NT-proBNP on assessment of coronary lesion and prognostic outcomes of patients with coronary heart disease（CHD）.Methods The data of 204 patients with CHD were collected to retrospectively study and divided into three groups,AMI group（68 cases,diagnosis to acute myocardial infarction）,UAP group（64 cases,diagnosis to unstable angina pectoris） and SAP group （72 cases,diagnosis to stable angina pectoris）,according to clinical diagnosis.And 70 persons,which physical examination was normal,were chosen to control group.The values of Hcy and NT-proBNP were compared among four groups.The scores of Gensini were calculated based on coronary arteriography （CAG） results and compared among three groups.Follow-up 6 months,the occurrence of major adverse cardiac events （MACE） was compared among three groups.The correlations of serum Hcy and NT-proBNP to Gensini scores and the occurrence of MACE were analyzed.Results The serum Hcy,NT-proBNP,Gensini scores and the occurrence of MACE were all different among four groups （P 〈 0.05）.The sequences were AMI group 〉 UAP group 〉 SAP group 〉 control group（P 〈 0.05）.The positive correlation between serum Hcy,NT-proBNP and Gensini scores was confirmed by Logistic correlation analysis（P 〈0.05）.The positive correlations between serum Hcy,NT-proBNP and the occurrence of MACE were confirmed by Logistic regression analysis （P 〈 0.05）.Conclusion The predictive value of Hcy and NT-proBNP on assessment of coronary lesion and prognostic outcomes of patients with CHD is perfect.