NT-proBNP、hs-CRP和超声心动图与急性冠状动脉综合征病变程度的相关性研究

目的：探讨血浆NT‐proBNP、hs‐CRP水平和彩色多普勒超声心动图与急性冠状动脉综合征（ACS）早期缺血坏死及冠状动脉病变严重程度的相关性。方法选择2013年3月至2014年2月因胸痛入住该院的患者，采集病史，所有患者入院24 h内测定血浆NT‐proBNP、hs‐CRP和cTnT水平，记录超声心动图左室射血分数（LVEF）值和右室舒张末内径（LVEDd）值，且住院期间行冠状动脉造影确诊。根据病史、心电图、冠状动脉造影、cTnT 结果分为ST 段抬高型心肌梗死（STEMI）组、非ST 段抬高型心肌梗死（NSTEMI）组、不稳定型心绞痛（UA）组及对照组。冠状动脉病病变严重程度根据冠状动脉造影结果分为单支病变组、双支病变组、三支病变组和阴性对照组。分析血浆NT‐proBNP、hs‐CRP水平及LVEF值在各组间的差异，多因素线性回归分析判断其是否为血浆NT‐proBNP的独立性危险因素。结果入组ACS患者共102例。对照组（n＝40）、UA组（n＝40）分别与NSTEMI组（n＝30）、STEMI组（n＝32）比较，患者血浆NT‐proBNP、hs‐CRP水平及LVEF值差异均有统计学意义（P＜0．05）。阴性对照组（n＝40）和三支病变组（n＝41）分别与单支病变组（n＝30）、双支病变组（n＝31）比较，血浆NT‐proBNP水平差有统计学意义异（P＜0．05）。多因素线性回归分析示：血浆hs‐CRP水平（P＝0．007）、冠状动脉病变支数（P＝0．001）、糖尿病病史（P＝0．006）均为血NT‐proBNP水平的独立正相关因素，LVEF值（P＝0．036）则为血NT‐proBNP水平的独立负相关因素。结论血浆NT‐proBNP、hs‐CRP水平、LVEF值与ACS关系密切，可作为判断其早期缺血坏死程度和临床分型的重要参考指标。血浆NT‐proBNP水平有可能作为一种判断冠状动脉病变严重程度的分子标志物。

NT-proBNP,hs-CRP and echocardiography:predictive value for the degree of coronary artery lesion

Objective To investigate the correlation between NT‐proBNP ,hs‐CRP level ,echocardiography and early avascu‐lar necrosis of coronary artery syndrome (ACS) ,coronary artery lesion degree .Methods 142 patients admitted in this hospital for chest pain from March 2013 to February 2014 were enrolled ,and all patients′history ,electrocardiogram (ECG) ,plasma levels of N‐terminal pro‐Brain Natriuretic Peptide (NT‐proBNP) ,hypersensitive C‐reative protein (hs‐CRP) and cTnT were recorded or tested within 24 hours ,while left ventricular ejection fraction (LVEF) and left ventricular end‐diastolic diameter (LVEDd) were recorded by echocardiography .According to the history and coronary angiography results conducted during hospitalization ,patients were di‐vided into acute ST segment elevation myocardial infarction (STEMI) group ,acute non‐ST segment elevation myocardial infarction (NSTEMI) group ,unstable angina pectoris (UA) group and control group (normal coronary angiography ,cTnT and ECG) .Pa‐tients with abnormal coronary angiography results were further divided into single vessel lesion group ,double vessel lesion group and triple vessel lesion group .The differences of plasma NT‐proBNP level ,hs‐CRP level and LVEF in each group ,and multivariate linear regression analysis were conducted to find out the independent risk factors for elevated plasma NT‐proBNP .Results 102 ACS patients and 40 normal patients were enrolled .Plasma levels of NT‐proBNP ,hs‐CRP and LVEF in NSTEMI group (n=30) and STEMI group (n=32) were significant different from UA group (n=40) and control group (n=40) respectively (P<0 .05) . The NT‐proBNP levels in control group and triple vessel lesion group (n=41) were respectively significant different from both sin‐gle vessel lesion group (n=30) and double vessel lesion group (n=31) (P<0 .05) .Multivariate linear regression analysis showed that ,plasma hs‐CRP level (P=0 .007) ,coronary artery lesion degree (P=0 .00) and history of diabetes (P=0 .006) were positive associated factors of NT‐proBNP level ,while LVEF was the negative associated factors of NT‐proBNP level(P=0 .036) .Conclusion Plasma NT‐proBNP level ,hs‐CRP level and LVEF are closely related to ACS ,and they might play an important role in determi‐ning the extent of early ischemic necrosis and clinical classification .Plasma NT‐proBNP level could be an important molecular mark‐er to reflect the degree of coronary artery lesion .