急性心肌梗死起病时不同水平超敏C反应蛋白的临床意义

Clinical significance of different levels of hypersensitive C-reaction protein at the onset of acute myocardial infarction

目的探讨急性心肌梗死(acute myocardial infraction,AMI)起病时不同水平超敏C反应蛋白(hypersensitive C-reaction protein,hsCRP)的临床意义。方法选取2013年1月至2018年1月于首都医科大学附属北京友谊医院行介入治疗的1610例AMI患者,根据起病时hsCRP水平将其分为hsCRP未升高组(hsCRP<10mg/L,977例)和hsCRP升高组(hsCRP≥10mg/L,633例);收集并分析两组患者的基线资料、住院期间炎症和凝血指标、冠状动脉造影及介入治疗信息、院内预后及用药情况等数据。结果hsCRP升高组患者的心率、入院随机血糖、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、白细胞、单核细胞、中性粒细胞、血小板体积分布宽度、国际标准化比值、纤维蛋白降解产物、D-二聚体、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、左回旋支闭塞率、左回旋支病变率、右冠状动脉病变率、Gensini积分、侧支循环发现率、主动脉内球囊反搏术使用率、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)峰值、肌钙蛋白I(troponin I,TnI)峰值、Killip≥2级比例、住院天数、左室舒张早期最大血流速度(E峰)与舒张晚期最大血流速度(A峰)的比值、β受体阻滞剂和利尿剂使用比例均显著高于hsCRP未升高组(P<0.05),三酰甘油、左室射血分数(left ventricular ejection fraction,LVEF)、抗凝血酶Ⅲ、凝血酶原时间活动度均显著低于hsCRP未升高组(P<0.05)。相关性分析显示,hsCRP水平与NLR、白细胞、单核细胞、中性粒细胞、Gensini积分、NT-proBNP峰值、LVEF、TnI峰值对数、心率、住院天数、D-二聚体和纤维蛋白原均有相关性(P<0.05)。结论hsCRP水平较高的患者,其应激程度更重,冠状动脉狭窄程度更高,侧支循环发现率略高,院内预后更差。

Objective To explore the clinical significance of different levels of hypersensitive C-reaction protein(hsCRP)at the onset of acute myocardial infarction(AMI).Methods A total of 1610 patients with AMI who received interventional treatment in Beijing Friendship Hospital,Capital Medical University from January 2013 to January 2018 were selected.According to the hsCRP level at onset,they were divided into hsCRP non-elevated group(977 cases with hsCRP<10mg/L)and hsCRP elevated group(633 cases with hsCRP≥10mg/L).Baseline data,indicators of inflammation and coagulation during hospitalization,information of coronary angiography and interventional therapy,in-hospital prognosis and medication were collected and analyzed.Results Heart rate,random blood glucose at admission,neutrophil-to-lymphocyte ratio(NLR),white blood cells,monocytes,neutrophils,platelet distribution width,international standardized ratio,fibrin degradation product,D-dimer,prothrombin time,activated partial thromboplastin time,fibrinogen,left cyclotron branch occlusion rate,left cyclotron branch disease rate,right coronary artery disease rate,Gensini score,detection rate of collateral circulation,intra-aortic balloon pump usage rate,peak value of N-terminal pro-brain natriuretic peptide(NT-proBNP),peak value of troponin I(TnI),proportion of Killip≥grade 2,hospitalization days,the ratio of early diastolic maximum blood flow velocity(E peak)to late diastolic maximum blood flow velocity(A peak)(E/A),β-blocker and diuretic use ratio in hsCRP elevated group were significantly higher than those in hsCRP non-elevated group(P<0.05),triacylglycerol,left ventricular ejection fraction(LVEF),antithrombinⅢand prothrombin time activity were significantly lower than those in hsCRP non-elevated group(P<0.05).Correlation analysis showed that hsCRP level was correlated with NLR,white blood cells,monocytes,neutrophils,Gensini score,peak value of NT-proBNP,LVEF,peak logarithm of TnI,heart rate,hospitalization days,D-dimer and fibrinogen(P<0.05).Conclusion Patients with higher levels of hsCRP had more severe stress,higher degree of coronary artery stenosis,slightly higher rate of collateral circulation discovery,and worse prognosis in hospital.