多重指标在急性冠脉综合症中的应用价值

The Application Value of Multiple Indexes in Acute Coronary Syndrome

目的探讨心肌同工酶MB(CK-MB)、N末端B型利钠肽前体(NT-proBNP)、高敏C反应蛋白(hs-CRP)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、脂蛋白(a)[Lp(a)]在急性冠脉综合症(ACS)患者中的临床价值。方法收集2017年10月~2018年2月中山市人民医院诊断为ACS患者85例作为ACS组,其中AMI56例、UA29例;KillipⅠ级25例、KillipⅡ级23例、Killip(Ⅲ~Ⅳ)级8例;单支血管病变25例、双支血管病变31例、三支血管病变29例,另选取85例健康体检者作为对照组,比较ACS组、对照组及ACS组中不同疾病类型、Killip心功能分级、冠脉造影结果间实验室指标[NT-proBNP、CK-MB、hs-CRP、HDL、TG、LDL、Lp(a)]差异。结果ACS组CK-MB、NT-proBNP、hs-CRP、TG、HDL均高于对照组,LDL低于对照组,差异有统计学意义(P<0.05);两组Lp(a)比较,差异无统计学意义(P>0.05)。AMI患者CK-MB、NT-proBNP、hs-CRP、HDL均高于UA患者,LDL低于UA患者,差异有统计学意义(P<0.05);两者TG和LP(a)比较,差异无统计学意义(P>0.05)。Killip(Ⅲ~Ⅳ)患者NT-proBNP、CK-MB、hs-CRP均高于KillipⅡ患者和KillipⅠ患者,且KillipⅡ患者高于KillipⅠ患者,差异有统计学意义(P<0.05);三者TG、LDL、HDL、LP(a)比较,差异无统计学意义(P>0.05)。单支血管病变患者NT-proBNP、CK-MB、hs-CRP均低于双支血管病变患者和三支血管病变患者,差异有统计学意义(P<0.05);三支血管病变患者NT-proBNP、hs-CRP均高于双支血管病变患者,差异有统计学意义(P<0.05);三者TG、LDL、HDL、LP(a)比较,差异无统计学意义(P>0.05)。结论血清CK-MB、NT-proBNP和hs-CRP与心功能分级和血管病变程度密切相关,且对ACS的诊断和病情的评估有一定应用价值。

Objective To explore myocardial isoenzyme MB(CK-MB),N-terminal B-type natriuretic peptide precursor(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP),triglyceride(TG),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),lipoprotein(a)[Lp(a)]clinical value in patients with acute coronary syndrome(ACS).Methods A total of 85 patients diagnosed with ACS from Zhongshan People's Hospital from October 2017 to February 2018 were collected as the ACS group,of which 56 were AMI and 29 were UA;25 cases of KillipⅠ,23 KillipⅡ,8 Killip(Ⅲ~Ⅳ);25 cases of single vessel disease,31 cases of double vessel disease,29 cases of three vessel disease.In addition,85 healthy subjects were selected as the control group to compare the ACS group with the control group and the ACS group in different disease types,Killip cardiac function classification,coronary angiography results and laboratory indicators[NT-proBNP,CK-MB,hs-CRP,HDL,TG,LDL,Lp(a)]difference.Results CK-MB,NT-proBNP,hs-CRP,TG,HDL in the ACS group were higher than those in the control group.LDL was lower than the control group,the difference was statistically significant(P<0.05);There was no significant difference in Lp(a)between the two groups(P>0.05).The CK-MB,NT-proBNP,hs-CRP,and HDL of AMI were higher than those of UA,and the LDL was lower than UA,the difference was statistically significant(P<0.05);There was no statistically significant difference between TG and LP(a)between the two(P>0.05).NT-proBNP,CK-MB and hs-CRP in Killip(Ⅲ~Ⅳ)were higher than KillipⅡand KillipⅠ,and KillipⅡwas higher than KillipⅠ,the difference was statistically significant(P<0.05);Comparison of TG,LDL,HDL,LP(a)among the three,the difference was not statistically significant(P>0.05).NT-proBNP,CK-MB,and hs-CRP in patients with single-vessel disease were lower than those with double-vessel disease and three-vessel disease,the difference was statistically significant(P<0.05);NT-proBNP and hs-CRP in three-vessel patients were higher than those with double-vessel disease,the difference was statistically significant(P<0.05);Comparison of TG,LDL,HDL,LP(a)among the three,the difference was not statistically significant(P>0.05).Conclusion Serum CK-MB,NT-proBNP and hs-CRP are closely related to the classification of heart function and the degree of vascular disease,and have certain application value in the diagnosis and evaluation of ACS.