脑钠肽、D-二聚体和超敏C反应蛋白在高龄冠心病的临床价值

Clinical value of brain natriuretic peptide,D-dimer and high sensitive C-reactive protein in elderly patients with coronary heart disease

目的探讨高龄冠心病(CHD)患者血浆脑钠肽(BNP)、超敏C反应蛋白(hsCRP)和D-二聚体(D-D)水平及其临床意义。方法将232例高龄CHD患者分为急性心肌梗死组(A组,78例)、不稳定型心绞痛组(B组,83例)和稳定型心绞痛组(C组,71例);另选取同期体检健康者作为对照组(D组,50例)。采用快速免疫荧光法检测各组血浆BNP水平,ELISA法检测D-D和hsCRP水平;随访1年内主要不良心脏事件(MACE)发生率。结果 A、B、C组血浆BNP、D-D和hsCRP水平依次降低(P<0.05)。CHD患者BNP水平与hsCRP和D-D均呈正相关(r=0.62和r=0.58,P<0.01)。随访期间,BNP>346pg/ml患者MACE发生率高于BNP≤346pg/ml患者(P<0.05)。结论 BNP与高龄CHD病变程度有明显的相关性,且对患者MACE的发生有很好的预测价值。

Objective To investigate the levels and clinical significance of brain natriuretic peptide（BNP）, high sensitive C-reactive protein （hsCRP） and D-dimer（D-D） in elderly patients with coronary heart disease（CHD）. Methods A total of 232 CHD patients was divided into three groups of A（with acute myocardial infarction, 78 cases）, B（with unstable angina pectoris, 83 cases） and C（with stable angina pectoris,71 cases）. Fifty healthy people were taken as the controls（group D）. Plasma BNP was measured by rapid immunofluoreseence assay, and the levels of D-D and hsCRP were detected by ELISA method. The major adverse cardiovascular events （MACE） of all patients were followed up for 1 year. Results The increase in the levels of BNP,D-D and hsCRP was in an order of group A〉group B〉group C（P〈0. 05）. Plasma level of BNP in CHD patients was positively correlated with that of hsCRP and D-D（r=0. 62 and r=0. 58,P〈0. 01）. The incidence of MACE in CHD patients with BNP〉346 pg/ml was significantly higher than that in those with BNP≤346 pg/ml （P〈0. 05）. Conclusion Plasma BNP is closely correlated with the severity of CHD and plays a predictive role in the occurrence of MACE.