血浆N末端前脑钠肽、P选择素与2型糖尿病合并急性冠脉综合征的相关性分析

Correlation analysis of plasma N-terminal pro-brain natriuretic peptide, P-selectin and type 2 diabetes mellitus complicated with acute coronary syndrome

目的探讨血浆N末端前脑钠肽(NT-pro-BNP)、P选择素(PS)是否为2型糖尿病(T2DM)患者合并急性冠脉综合征(ACS)的危险因素。方法选取2017年7月-2018年4月廊坊市中医医院及华北理工大学附属医院心内科收治的228例因胸痛入院的患者,分为T2DM组(n=32)、ACS组(n=124)及T2DM合并ACS组(DA组,n=72)。采用酶联免疫法测定患者血浆NT-pro-BNP及PS水平,空腹取静脉血完成一般生化指标检测。采用Judkins法行冠脉造影术,依据冠脉造影结果,采用Gensini评分评价患者冠脉狭窄的程度。比较三组的一般临床资料,采用logistic回归分析T2DM患者发生ACS的危险因素。结果三组间性别、高血压病史、吸烟、体重指数、年龄、血肌酐水平比较差异均无统计学意义;DA组低密度脂蛋白胆固醇水平高于T2DM组、ACS组[(3.16±0.98)mmol/L vs.(2.83±0.91)mmol/L、(2.84±0.92)mmol/L],三酰甘油水平高于T2DM组、ACS组[(2.21±1.36)mmol/L vs.(1.65±1.05)mmol/L、(1.68±0.97)mmol/L],差异均有统计学意义(P<0.05);DA组左室射血分数低于T2DM组、ACS组[(58.97±7.35)%vs.(63.48±7.37)%、(61.26±7.68)%],差异有统计学意义(P<0.01);DA组的PS为(48.30±13.61)ng/L,高于ACS组[(38.87±9.12)ng/L],且ACS组高于T2DM组[(21.46±12.30)ng/L];DA组的高敏C反应蛋白为(27.63±11.87)mg/L,高于ACS组[(20.21±9.32)mg/L],且ACS组高于T2DM组[(10.30±4.22)mg/L];DA组的NT-pro-BNP [M(Q1,Q3)]为419(154,1350)pg/ml,高于ACS组[120(43,416)pg/ml],且ACS组高于T2DM组[22(12,54)pg/ml];DA组的Gensini评分为(138.39±88.31)分,高于ACS组[(82.12±63.08)分],且ACS组高于T2DM组[(39.98±32.12)分],差异均有统计学意义(P<0.01)。多因素logistic回归分析显示PS、高敏C反应蛋白水平升高是T2DM患者发生ACS的危险因素,OR值分别为1.138(95%CI:1.089～1.190,P<0.01)、1.656(95%CI:1.189～2.307,P<0.01)。结论 PS和高敏C反应蛋白水平升高是T2DM患者发生ACS的独立危险因素,NT-pro-BNP与T2DM患者发生ACS无关。

Objective To investigate the relationship between plasma N-terminal pro-brain natriuretic peptide(NT-proBNP), P-selectin(PS) and type 2 diabetes mellitus(T2 DM) patients with acute coronary syndrome(ACS). Methods Two hundred and twenty-eight patients with chest pain, admitted in the Department of Cardiology of Langfang Traditional Chinese Medicine Hospital and the Affiliated Hospital of North China University of Science and Technology from July 2017 to April 2018, were selected in present study, including 32 patients with T2 DM, 124 patients with ACS, and 72 patients with T2 DM complicated with ACS(DA group). ELISA was performed to detect the levels of plasma NT-pro-BNP and PS, and venous blood was taken on an empty stomach to complete a general biochemical project. Based on the results of coronary angiography performed by using Judkins method,the Gensini score was used to evaluate the degree of coronary stenosis. The general clinical data of the 3 groups were compared,and logistic regression was performed to analyze the risk factors for ACS in patients with T2 DM. Results No statistical difference existed in gender, history of hypertension, smoking, body mass index, age, and creatinine among the three groups;The levels of lowdensity lipoprotein cholesterol and triglyceride were higher in DA group [(3.16±0.98)mmol/L and(2.21±1.36)mmol/L] than in T2 DM and ACS group [(2.83±0.91)mmol/L,(1.65±1.05)mmol/L and(2.84±0.92)mmol/L,(1.68±0.97)mmol/L] with significant difference(P<0.05). The left ventricular ejection fraction was lower in DA group(58.97±7.35)% than in T2 DM and ACS groups [(63.48±7.37)% and(61.26±7.68)%, respectively] with statistically significant difference(P<0.01). The PS was higher in DA group(48.30±13.61)ng/L than in ACS group(38.87±9.12)ng/L, and in ACS group than in T2 DM group(21.46±12.30)ng/L;The C-reactive protein was higher in DA group [(27.63±11.87)mg/L] than in ACS group(20.21±9.32)mg/L, and in ACS group than in T2 DM group [(10.30±4.22)mg/L];The NT-pro-BNP M(Q1, Q3) was higher in DA group [419(154, 1350)pg/ml] than in ACS group [120(43, 416)pg/ml], and in ACS group than in T2 DM group [22(12, 54)pg/ml];The Gensini scores was higher in DA group(138.39±88.31) than in ACS group(82.12±63.08), and in ACS group than in T2 DM group(39.98±32.12), all the differences listed above were statistically significant(P<0.01). It had been confirmed by multivariate logistic regression analysis that the levels of PS and high-sensitivity C-reactive protein were the risk factors for ACS in patients with DM, their OR estimates were1.138(95%CI 1.089-1.990, P<0.01) and 1.656(95%CI 1.189~2.307, P<0.01), respectively. Conclusion High levels of PS and high-sensitivity C-reactive protein are the independent risk factors for ACS in patients with T2 DM. NT-pro-BNP was not associated with ACS in patients with T2 DM.