PCI术后2型糖尿病合并冠心病患者心功能分级与hs-CRP水平及预后的相关性研究

Clinical study on relationship of hs-CRP level with presence and prognosis of cardiac dysfunction in patients with type 2 diabetes after percutaneous coronary intervention

目的探讨2型糖尿病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与心功能不全及预后的相关性。方法选择符合纳入标准的PCI后合并2型糖尿病心功能不全患者120例,选择同期健康体检者42名为对照组,收集研究对象血脂、hs-CRP、脑钠素(Brain natriuretic peptide,BNP)、超声心动相关指标等临床基线资料。进行1年的随访,包括死亡、心肌梗死、脑卒中和再次血运重建等主要不良心脑血管事件(main adverse cardiovascular and cerebrovascular events,MACCE),并对数据进行统计学分析。结果入选的心功能不全患者按照美国NYHA心功能分级标准:(Ⅰ级+Ⅱ级)为C组,Ⅲ级为D组,Ⅳ级为E组,此三组的hs-CRP,BNP,左室舒张末容积(left ventricular end diastolic volume,LVEDV)、左室收缩末容积(left ventricular end systolic volume,LVESV),明显高于对照组,差异有统计学意义(P<0.05);而其随着心功能分级的增加,其数值逐步增加,各组间比较有统计学意义,心功能不全的三组左室射血分数(left ventricular ejection fraction,LVEF)显著低于对照组,而其随着心功能分级的增加,其数值逐步降低,各组间比较差异有统计学意义P<0.05;通过直线回归分析,hs-CRP的水平和BNP呈正相关(r=0.52,P<0.05);而和LVEF呈负相关,(r=-0.67,P<0.05);hs-CRP和LVEDV,LVESV无相关;BNP和LVEDV,LVESV呈正相关(r=0.42,P<0.05;r=0.39,P<0.05);和LVEF呈负相关(r=-0.78,P<0.05)。故BNP在诊断和评价心力衰竭时优于hs-CRP。按是否出现MACCE分组后,进一步行多因素logistic回归分析,显示hs-CRP、BNP为患者发生MACCE的独立预测因子(P<0.05)。结论 hs-CRP是发生心功能不全的独立预测因子,能有效评估心功能不全的发病风险及其预后,故hs-CRP检测对评估心血管疾病具有很好的应用价值。

Objective To investigate the relationship of high-sensitivity C-reactive protein（ hs-CRP） level with cardiac dysfunction in patients with type 2 diabetes after percutaneous coronary interventions（ PCI） for coronary heart disease（ CHD） and its prognostic value. Methods 120 patients who suffered from cardiac dysfunction with type 2 diabetes after PCI for CHD were included in this study,and another 42 healthy people getting check-ups were selected as control group. Clinical baseline levels for blood lipids,hsCRP,BNP and echocardiography were obtained. Follow-ups of main adverse cardiovascular and cerebrovascular events（ MACCE） including death,myocardial infarction,stroke and repeated revascularization were done for 12 months. Data analysis using SPSS statistical software was conducted. Results Patients with cardiac dysfunction were divided into three groups by NYHA heart function classification,including Group C（ class Ⅰ and Ⅱ）,Group D（ class Ⅲ）,Group E（ class Ⅳ）,The levels of hs-CRP,BNP,left ventricular end diastolic volume（ LVEDV） and left ventricular end systolic volume（ LVESV） in all these three groups were obviously higher than those in the control group,and along with the increase of heart function classification,the levels increased; there was statistically significant difference（ P〈0. 05）. The left ventricular ejection fraction（ LVEF） levels were obviously higher than that in the control group,and decreased with the increase of heart function classification; the difference was statistically significant（ P〈0. 05）. Linear regression analysis showed positive correlation between hs-CRP and BNP,（ r = 0. 52,P〈0. 05） and negative correlation between hsCRP and LVEF,（ r =（ 0. 67,P〈0. 05）; hs-CRP was independent of LVEDV and LVESV; there was positive correlation between BNP and LVEDV,LVESV,（ r = 0. 42,P〈0. 05; r = 0. 39,P〈0. 05,respectively）,and negative correlation with LVEF,（ r =- 0. 78,P〈0. 05）. BNP was superior to hs-CRP in the evaluation and diagnosis of heart failure. Further multivariate logistic regression analysis after grouping according to the occurrence of MACEE showed that both hs-CRP and BNP were independent risk factors of MACEE（ P〈0. 05）. Conclusion hs-CRP is independent predictor for cardiac dysfunction. It can effectively help assess the present risk and prognosis of cardiac dysfunction,and has great clinical value in detecting and evaluating cardiovascular diseases.