血清脑钠肽、超敏肌钙蛋白T水平与老年冠心病患者冠状动脉狭窄的关系

Relationship among brain natriuretic peptide,high sensitivity cardiac troponin T and coronary artery stenosis in elderly patients with coronary heart disease

目的探讨血清脑钠肽(BNP)、超敏肌钙蛋白T(hs-cTnT)水平与老年冠状动脉粥样硬化性心脏病(冠心病,CHD)患者冠状动脉狭窄的关系。方法选取2020年10月至2023年10月于桐城市人民医院收治的192例老年冠心病患者作为研究对象(研究组),再根据冠状动脉Gensini积分评价患者冠状动脉狭窄情况,分为低中危组(n=114)和高危组(n=78)。另选取同期100例我院行冠状动脉造影正常的老年患者作为对照组。检测并比较所有研究对象的血清BNP、hs-cTnT水平。采用Pearson相关分析探讨血清BNP、hs-cTnT水平与冠状动脉Gensini积分的关系,采用受试者工作特性(ROC)曲线评估血清BNP、hs-cTnT对老年冠心病患者冠状动脉重度狭窄的评估价值,多因素Logistic逐步回归分析探讨老年冠心病患者重度狭窄的影响因素。结果研究组血清BNP、hs-cTnT水平明显高于对照组(P<0.05)。重危组血清BNP、hs-cTnT水平明显高于低中危组(P<0.05)。老年冠心病患者血清BNP、hs-cTnT与冠状动脉Gensini积分均呈显著正相关(P<0.05)。血清BNP、hs-cTnT评估老年冠心病患者冠状动脉重度狭窄AUC分别为0.729、0.836,两者联合评估AUC为0.904。重危组患者高脂血症、高血压、2型糖尿病、肥胖比例、LDL-C均高于低中危组,HDL-C低于低中危组(P<0.05)。多因素回归分析显示:高血压(OR=1.835,95%CI:1.041~3.233)、2型糖尿病(OR=1.791,95%CI:1.089~2.947)、血清BNP≥342.21 ng/L(OR=2.067,95%CI:1.375~3.107)、血清hs-cTnT≥186.53 pg/L(OR=2.351,95%CI:1.486~3.720)是老年冠心病患者冠状动脉重度狭窄的危险因素(P<0.05)。结论血清BNP、hs-cTnT在老年冠心病重度狭窄患者中呈高表达,且与冠状动脉狭窄程度呈正相关。

Objective To discuss the relationship among brain natriuretic peptide(BNP),high sensitivity cardiac troponin T(hs-cTnT)and coronary artery stenosis in elderly patients with coronary heart disease(CHD).Methods Elderly CHD patients(n=192)were chosen into study group from People’s Hospital of Tongcheng City from Oct.2020 to Oct.2023.The status of coronary artery stenosis was reviewed according to Gensini scores,and the patients in study group were divided into low-medium-risk group(n=114)and high-risk group(n=78).Meanwhile the elderly patients with normal coronary angiography(CAG,n=100)were chosen into control group.The levels of BNP and hs-cTnT were detected and compared in all groups.The relationship among levels of BNP and hs-cTnT and Gensini scores of coronary artery was analyzed by using Pearson correlation analysis.The assessment value of BNP and hs-cTnT to severe coronary artery stenosis was reviewed by using ROC curve.The influence factors of severe coronary artery stenosis were investigated by using multiple Logistic stepwise regression analysis.Results The levels of BNP and hs-cTnT were significantly higher in study group than those in control group(P<0.05).The levels of BNP and hs-cTnT were significantly higher in high-risk group than those in lowmedium-risk group(P<0.05).The levels of BNP and hs-cTnT were positively correlated to Gensini scores in elderly CHD patients(P<0.05).In assessing severe coronary artery stenosis,AUC of BNP was 0.729,AUC of hs-cTnT was0.836,and AUC of BNP combined with hs-cTnT was 0.904.The percentages of hyperlipidemia,hypertension,type 2 diabetes mellitus(T2DM)and obesity,and level of low-density lipoprotein-cholesterol(LDL-C)were higher,and level of high-density lipoprotein-cholesterol(HDL-C)was lower in high-risk group than those in lowmedium-risk group(P<0.05).The results of multiple Logistic stepwise regression analysis showed that hypertension(OR=1.835,95%CI:1.041~3.233),T2DM(OR=1.791,95%CI:1.089~2.947),BNP≥342.21 ng/L(OR=2.067,Cardiovasc Med,June,2024,Vol.16,No.695%CI:1.375~3.107)and hs-cTnT≥186.53 pg/L(OR=2.351,95%CI:1.486~3.720)were risk factors of severe coronary artery stenosis in elderly CHD patients.Conclusion The expressions of serum BNP and hs-cTnT are higher in elderly CHD patients with severe coronary artery stenosis,which are positively correlated to severity of coronary artery stenosis.