早发冠心病患者心脏标志物四项、PCT、BNP水平的变化及临床意义

Changes and clinical significance of four cardiac markers,procalcitonin,and B-type brain natriuretic peptide levels in patients with premature coronary heart disease

目的探讨早发冠心病患者心脏标志物四项、降钙素原(PCT)、B型脑钠肽(BNP)水平的变化及临床意义。方法选择2018年3月至2020年12月西安市临潼区人民医院心血管内科收治的80例早发冠心病患者为研究对象,并作为观察组,另选择同期在上述医院接受体检的80例健康者作为对照组。比较两组受检者纳入研究后次日心脏标志物四项[肌钙蛋白(cTnI)、氨基末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、肌酸激酶同工酶(CK-MB)]和PCT、BNP水平,比较观察组不同病变支数、不同管腔狭窄程度患者的血清cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平,并采用Pearson相关性分析法分析冠状狭窄程度积分(Gensini)与cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平的相关性。结果观察组患者的血清cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平分别为(5.42±1.48)ng/mL、(983.21±346.29)pg/mL、(26.29±3.61)mg/L、(47.23±5.72)U/L、(0.63±0.15)ng/mL、(328.93±74.07)pg/mL,明显高于对照组的(0.23±0.05)ng/mL、(60.72±9.30)pg/mL、(0.80±0.14)mg/L、(6.82±2.06)U/L、(0.11±0.03)ng/mL、(36.83±5.06)pg/mL,差异均有统计学意义(P<0.05);观察组中多支病变组患者的血清cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平分别为(7.21±1.62)ng/mL、(1202.37±261.34)pg/mL、(46.17±4.63)mg/L、(57.23±4.72)U/L、(0.91±0.24)ng/mL、(517.34±92.73)pg/mL,明显高于双支病变组的(5.32±1.80)ng/mL、(899.61±290.52)pg/mL、(28.05±3.09)mg/L、(48.11±3.49)U/L、(0.65±0.17)ng/mL、(339.23±68.36)pg/mL,和单支病变组的(3.79±1.06)ng/mL、(637.23±185.92)pg/mL、(17.23±3.41)mg/L、(41.02±3.86)U/L、(0.48±0.13)ng/mL、(219.23±41.58)pg/mL,且双支病变组患者各指标均明显高于单支病变组,差异均具有统计学意义(P<0.05);观察组中重度狭窄组患者的Gensini评分、血清cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平分别为(52.92±7.30)分、(7.45±1.99)ng/mL、(1199.84±275.02)pg/mL、(49.92±3.82)mg/L、(60.14±6.92)U/L、(0.93±0.19)ng/mL、(530.91±113.02)pg/mL,明显高于中度狭窄组的(30.72±6.12)分、(5.17±1.69)ng/mL、(926.17±235.61)pg/mL、(27.62±3.41)mg/L、(45.71±4.33)U/L、(0.69±0.14)ng/mL、(361.38±73.91)pg/mL和轻度狭窄组的(13.02±3.41)分、(3.58±1.24)ng/mL、(618.29±202.57)pg/mL、(18.02±2.78)mg/L、(38.18±3.10)U/L、(0.46±0.15)ng/mL、(202.74±37.95)pg/mL,且中度狭窄组患者各指标均明显高于轻度狭窄组,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,Gensini评分与cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP均呈正相关(r=0.385、0.412、0.341、0.295、0.328、0.341,P<0.05)。结论早发冠心病患者血清cTnI、NT-proBNP、hs-CRP、CK-MB、PCT、BNP水平的表达均明显升高,在疾病的发生和发展过程中具有重要的检测意义。

Objective To study the changes and clinical significance of four cardiac markers,procalcitonin(PCT),and B-type brain natriuretic peptide(BNP)levels in patients with premature coronary heart disease.Methods A total of 80 patients with premature coronary heart disease admitted to Department of Cardiology,Xi'an Lintong District People's Hospital from March 2018 to December 2020 were selected as the observation group,and 80 healthy people who received physical examination in our hospital during the same period were selected as the control group.The cardiac markers four items[cardiac troponin(cTnI),N-terminal pro brain natriuretic peptide(NT-proBNP),high sensitivity C reactive protein(hs-CRP),creatine kinase isozyme(CK-MB)]and PCT and BNP levels between the two groups were compared at next day after inclusion,and the serum cTnI,NT-proBNP,hs-CRP,CK-MB,PCT,and BNP levels were compared among patients with different number of lesions,different degree of lumen stenosis in the observation group.Pearson correlation analysis was used to analyze the correlation between Coronary stenosis score(Gensini)and cTnI,NT proBNP,hs CRP,CK-MB,PCT,BNP levels.Results The serum cTnI,NT-proBNP,hs-CRP,CK-MB,PCT,and BNP levels in the observation group were (5.42±1.48) ng/mL, (983.21±346.29) pg/mL, (26.29±3.61) mg/L, (47.23±5.72) U/L,(0.63±0.15) ng/mL, (328.93±74.07) pg/mL, which were significantly higher than (0.23±0.05) ng/mL, (60.72±9.30) pg/mL,(0.80±0.14) mg/L, (6.82±2.06) U/L, (0.11±0.03) ng/mL, (36.83±5.06) pg/mL in the control group (P<0.05). The serumcTnI, NT-proBNP, hs-CRP, CK-MB, PCT, and BNP levels in the multi vessel disease group of the observation groupwere (7.21 ± 1.62) ng/mL, (1 202.37 ± 261.34) pg/mL, (46.17 ± 4.63) mg/L, (57.23 ± 4.72) U/L, (0.91 ± 0.24) ng/mL,(517.34±92.73) pg/mL, which were significantly higher than (5.32±1.80) ng/mL, (899.61±290.52) pg/mL, (28.05±3.09) mg/L, (48.11±3.49) U/L, (0.65±0.17) ng/mL, (339.23±68.36) pg/mL in double vessel disease group, and (3.79±1.06) ng/mL, (637.23±185.92) pg/mL, (17.23±3.41) mg/L, (41.02±3.86) U/L, (0.48±0.13) ng/mL, (219.23±41.58) pg/mLin single vessel disease group;the results of each index in double vessel disease group were significantly higher thanthat in single vessel disease group, and the differences were statistically significant (P<0.05). The Gensini score, serumcTnI, NT-proBNP, hs-CRP, CK-MB, PCT, and BNP levels in the severe stenosis group were (52.92±7.30) points,(7.45±1.99) ng/mL, (1 199.84±275.02) pg/mL, (49.92±3.82) mg/L, (60.14±6.92) U/L, (0.93±0.19) ng/mL, (530.91±113.02) pg/mL, which were significantly higher than (30.72±6.12) points, (5.17±1.69) ng/mL, (926.17±235.61) pg/mL,(27.62±3.41) mg/L, (45.71±4.33) U/L, (0.69±0.14) ng/mL, (361.38±73.91) pg/mL in the moderate stenosis group, and(13.02±3.41) points, (3.58±1.24) ng/mL, (618.29±202.57) pg/mL, (18.02±2.78) mg/L, (38.18±3.10) U/L, (0.46±0.15) ng/mL,(202.74±37.95) pg/mL in the mild stenosis group;the results of each index in moderate stenosis group were significantlyhigher than that in mild stenosis group, and the differences were statistically significant (P<0.05). Pearson correlationanalysis showed that Gensini score was positively correlated with cTnI, NT-proBNP, hs-CRP, CK-MB, PCT and BNP(r=0.385, 0.412, 0.341, 0.295, 0.328, 0.341, P<0.05). Conclusion The expression of serum cTnI, NT-proBNP, hs-CRP,CK-MB, PCT, BNP level is significantly increased in patients with early coronary heart disease, which has an importantdetection significance in the occurrence and development of the disease.