类风湿关节炎合并急性冠状动脉综合征患者血清脑钠肽水平及心功能特点分析

Cardiac function and brain natriuretic peptide in patients with acute coronary syndrome complicated with rheumatoid arthritis

目的 探讨类风湿关节炎（RA）合并急性冠状动脉综合征（ACS）患者血清脑钠肽水平及心功能的特点.方法 选择2012年1月至2013年6月于首都医科大学附属北京安贞医院住院的合并RA的ACS患者68例作为研究对象（观察组）,另选不合并RA的ACS患者65例作为对照组.记录并比较2组患者年龄、性别、体重指数、收缩压、舒张压及传统心血管病危险因素.全自动生化仪检测并比较2组患者血清高敏C反应蛋白（hs-CRP）、红细胞沉降率（ESR）、三酰甘油、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）及血清脑钠肽水平的差异.超声心动图评价左心室收缩及舒张功能,并比较2组差异.结果 观察组患者体重指数高于对照组,差异有统计学意义[（28±4） kg/m2比（25±4）kg/m2,P＜0.05].2组患者年龄、性别、收缩压、舒张压、传统心血管病因素和三酰甘油、总胆固醇、LDL-C水平比较,差异均无统计学意义（均P＞0.05）.观察组患者HDL-C水平明显低于对照组[（1.0±0.3）mmol/L比（1.2±0.2）mmol/L],血清hs-CRP、ESR、Hcy水平明显高于对照组[（10±6） mg/L比（4 ±3）mg/L,（28±16）mm/1 h比（94） mm/1 h,（17 ±6） μmol/L比（14 ±4） μmol/L],差异均有统计学意义（均P＜ 0.05）.观察组患者血清脑钠肽水平明显高于对照组[（387±226） ng/L比（258±139） ng/L]、LVEF明显低于对照组[（44±13）％比（61±10）％],差异均有统计学意义（均P＜0.05）.观察组有66例（96.7％）,对照组有40例（62.3％）患者左心室舒张功能减低,2组比较差异有统计学意义（P＜0.01）.结论 与不合并RA的ACS患者相比,合并RA的ACS患者心脏收缩和舒张功能更低,血清脑钠肽水平更高,这可能与RA患者本身持续的炎症状态导致心脏损害有关.

Objective To investigate the cardiac function and brain natriuretic peptide （BNP） level in patients with acute coronary syndrome （ACS） complicated with rheumatoid arthritis （RA）.Methods Sixty-eight ACS patients complicated with RA （observation group） and 65 ACS patients without RA （control group） from January 2012 to June 2013 were enrolled.The age,gender,body mass index （BMI）,blood pressure,relative risk factors of cardiovascular disease were recorded and compared between the two groups.The levels of high sensitivity C reactive protein （hs-CRP）,erythrocyte sedimentation rate （ESR）,serum triglyceride （TG）,total cholesterol （TC）,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C）,homocysteine （Hcy） and serum brain natriuretic peptide （BNP） were compared between the two groups.The echocardiography was used to determine the changes of cardiac morphology and function.Results The BMI was significantly higher in observation group than that in control group [（28 ±4） kg/m2 vs （25 ±4） kg/m2].There were no differences regarding the age,gender,blood pressure,relative risk factors of cardiovascular disease,and the levels of TG,TC and LDL-C between the two groups.The HDL level was significantly lower in observation group than that in control group[（1.0 ±0.3） mmol/L vs （1.2 ± 0.2） mmol/L] （P 〈 0.05）.The serum CRP,ESR and Hcy levels in observation group were significantly higher than those in control group[（10 ± 6） mg/L vs （4 ± 3） mg/L,（28 ± 16） mm/1 h vs （9 ±4） mm/1 h,（17 ±6） μmol/L vs （14 ±4） μmol/L] （P〈0.05）.The level of BNP was significantly higher and the LVEF was significantly lower in observation group than that in control group [（387 ± 226）ng/L vs （258 ± 139） ng/L,（44 ± 13）% vs （61 ± 10）%].Reduction of diastolic function was found in 66 cases （96.7%） of observation group,higher than that in control group [62.3% （40/65）] （P 〈 0.01）.Conclusions ACS patients complicated with RA are more likely to be afflicted with the reduction of left ventricular functions with higher BNP compared with ACS patients without RA,which might be related to the inflammation.