血清同型半胱氨酸、N-末端脑钠肽前体水平与老年冠心病患者冠状动脉病变程度的相关性研究

Correlation between serum homocysteine,N -terminal brain natriuretic peptide levels and extent of coronary artery lesions in elderly patients with coronary heart disease

目的：探讨老年冠心病患者血清同型半胱氨酸（Hcy）、N-末端脑钠肽前体（NT-proBNP）水平与冠状动脉病变程度之间的关系及意义。方法选择行冠脉造影检查、年龄≥60岁的冠心病患者129例为研究对象，检测血清 Hcy 及 NT-proBNP 水平，并行冠脉造影检查，造影结果正常24例（对照组）、稳定型心绞痛（SAP 组）28例，非 ST 段抬高型急性冠状动脉综合征（NSTEACS 组）47例、急性 ST 段抬高型心肌梗死（AMI组）30例，采用 Gensini 评分评估冠状动脉病变严重程度，并分析患者血清 Hcy、NT-proBNP 水平与冠脉造影冠状动脉病变程度之间的关系。结果 AMI 组血清 Hcy、NT-proBNP 水平分别为（18．13±8．26）μmol／L、（450.45±230．45）pg／mL，显著高于 NSTEACS 组[（16．96±9．04）μmol／L、（300．96±170．94）pg／mL]、SAP 组[（14．35±5．31）μmol／L、（130．35±85．31）pg／mL]及对照组[（10．19±3．18）μmol／L、（65．19±40．18）pg／mL]（t ＝5．73、3．64；t ＝5．53、3．23；t ＝4．96、3．46；均 P ＜0．05），NSTEACS 组平均 Hcy、NT-proBNP 水平明显高于SAP 组及对照组（t ＝5．06，3．54；t ＝4．79，3．25；均 P ＜0．05），SAP 组平均 Hcy、NT-proBNP 水平高于对照组（t ＝5．89，4．23；P ＜0．05）。冠脉狭窄多支病变、双支病变、单支病变患者血清 Hcy、NT-proBNP 水平分别为（16．13±7．26）μmol／L、（14．35±7．29）μmol／L、（12．67±6．48）μmol／L；（416．45±210．45）pg／mL、（240．54±160．71）pg／mL、（120．76±140．57）pg／mL，三组比较差异均有统计学意义（F ＝13．15、140．25，P ＜0．05、P ＜0.01）。血清 Hcy、NT-proBNP 水平与 Gensini 评分有明显相关性（r ＝0．342，P ＜0．05；r ＝0．962，P ＜0．01）。结论血清 Hcy、NT-proBNP 水平与老年冠心病患者冠状动脉病变程度、狭窄支数呈正相关。测定血清 Hcy、NT-proBNP 水平对于老年冠心病患者的冠脉病变程度和病情的评估具有重要的临床意义。

Objective To investigate the relationship between serum homocysteine （Hcy）and N -terminal brain natriuretic peptide （NT -proBNP）and the severity of coronary artery disease in elderly patients with coronary heart disease （CHD）.Methods 129 cases of inpatient with concurrent coronary angiography whose age was over 60 years old were selected as the research object.Serum Hcy and NT proBNP level were detected,and parallel coronary angiography were administrated.Angiography was normal in 24 cases （CONTROL group）,while 28 cases were stable angina pectoris（SAP group）,non ST segment elevation acute coronary artery comprehensive syndrome group （NSTEACS group）had 47 cases,acute ST segment elevation myocardial infarction group had 30 cases（AMI group）.was used to The severity of coronary artery lesions were assessed by Gensini score and the relationship be-tween serum Hcy and NT proBNP levels and coronary angiography in the diagnosis of coronary artery disease severity were analyzed.Results AMI group,the mean serum Hcy and NT proBNP levels[（18.13 ±8.26）μmol/L,（450.45 ± 230.45）pg/mL]were significantly higher than those of NSTEACS group [（16.96 ±9.04）μmol/L,（300.96 ± 170.94）pg/mL],SAP group[（14.35 ±5.31）μmol/L,（130.35 ±85.31）pg/mL]and control group[（10.19 ± 3.18）μmol/L,（65.19 ±40.18）pg/mL]（t =5.73、3.64;t =5.53、3.23;t =4.96、3.46;P 〈0.05）.In NSTEACS group,average of Hcy and NT proBNP levels were significantly higher than those of SAP group and control group （t =5.06,3.54;t =4.79,3.25;P 〈0.05）.In SAP group,the average of Hcy and NT proBNP levels were higher than those in the control group （t =5.89,4.23;P 〈0.05）.The levels of serum Hcy and NT -proBNP in patients with cor-onary artery stenosis,double vessel disease and single vessel disease were（16.13 ±7.26）mol/L,（7.29 ±14.35）mol/L, （12.67 ±6.48）pg/mL,（210.45 ±416.45）pg/mL and （160.71 ±140.57）pg/mL,the difference was statistically significant （F =140.25,F =13.15;P 〈0.05,P 〈0.01）.The levels of serum Hcy and NT -proBNP were signifi-cantly correlated with Gensini score （r =0.342,P 〈0.05;r =0.962,P 〈0.01）.Conclusion Correlation between serum Hcy,NT -proBNP levels in elderly patients with coronary heart disease and the severity of coronary artery disease and stenosis count is positive.Determining the levels of serum Hcy and NT -proBNP in patients with coronary heart disease and the assessment of the severity of the disease has important clinical significance.