【作者】 朱长友；

【导师】 李继福；

【作者基本信息】 山东大学 ， 心血管病（专业学位）， 2013， 硕士

【摘要】 目的：分析稳定型心绞痛、不稳定型心绞痛和急性心肌梗死患者中的血浆N-末端脑钠肽前体水平,研究血浆N-末端脑钠肽前体水平与冠状动脉造影证实的冠状动脉病变严重程度之间的关系及可能的临床意义。对象和方法：选取2011年1月至2012年1月期间入住济南市第三人民医院心内科的82例患者入选本研究。依据患者临床表现、心电图及心肌损伤标记物分为三组：稳定型心绞痛组(SA,n=23例)、不稳定型心绞痛组(UA,n=28例)、急性心肌梗死组(AMI, n=31例)。82例患者入院后均行冠状动脉造影及冠脉狭窄程度的评分(Gensini评分),同时选20例与研究组年龄、性别相匹配,因胸痛就诊但冠状动脉造影正常的患者作为正常对照组。所有入选本研究的患者均于入院后行冠状动脉造影,冠状动脉狭窄与否和狭窄程度通过目测法来判定。根据冠状动脉造影结果进一步将冠脉狭窄组分为一支病变组(n=22例),二支病变组(n=31例),三支病变组(n=29例)以及前降支病变组(n=8例)、回旋支病变组(n=5例)和右冠状动脉病变组(n=8例)。并在行冠状动脉造影前晨起从周围静脉中留取血样本,本研究采用电化学发光法测定血浆NT-proBNP水平,严格按试剂规定方式操作,分别检测冠心病各组与对照组,以及冠状动脉不同病变支数、不同病变部位的血浆NT-proBNP水平,并进行Gensini评分及TIMI血流评分,同时检测急性心肌梗死组cTnI水平。采用SPSS17.0统计软件进行统计学分析。所有计量资料用均数±标准差表示,两个样本的均数检验使用t检验,多个样本的均数检验采用方差分析,相关性检验采用spearman相关分析。P<0.05为差异有显著性意义。结果：1.AMI组血浆NT-proBNP水平明显高于UA组、SA组和对照组,UA组血浆NT-proBNP明显高于SA组和对照组,SA组血浆NT-proBNP高于对照组,差异均有统计学意义(p均<0.05)。2.在冠心病患者中,三支病变组的血浆NT-proBNP水平高于二支病变组和一支病变组,差异均有统计学意义,P分别<0.05和<0.01。3.AMI组的血浆NT-proBNP水平与cTnI水平呈正相关,结果有统计学意义(r==0.895,p<0.01)。4.前降支病变组的血浆NT-proBNP水平明显高于右冠脉病变组和回旋支病变组,差异亦均有统计学意义,P均<0.01。5.冠心病患者血浆NT-proBNP水平与Gensini积分呈正相关(r==0.963,p<0.01),与TIMI血流评分呈负相关(r=-0.39,P<0.01),结果均有统计学意义。结论：1.冠心病患者的血浆NT-proBNP水平显著增高,提示血浆NT-proBNP水平可用于预测心肌缺血的严重程度。2.冠脉病变支数越多,犯罪血管越重要,血浆NT-proBNP水平越高,提示血浆NT-proBNP水平可用于预测冠状动脉病变的严重程度。3.急性心肌梗死患者血浆NT-proBNP水平与cTnI水平明显正相关,提示血浆NT-proBNP水平可作为预测AMI中心肌缺血的严重程度,可提示作为重要的诊断指标之一。4、血浆NT-proBNP水平与Gensini评分有呈正相关,与TIMI血流评分呈负相关,提示NT-proBNP升高越明显,心肌缺血越严重。5.血浆NT-proBNP水平对冠心病患者危险评估有一定价值。更多还原

【Abstract】 Objective:To evaluate plasma NT-proBNP levels in patients with stable angina unstable angina or acute myocardial infarction, and to investigate the relationship between the NT-proBNP levels and the severity and extent of involved coronary vessels.Objects and Methods:82patients with coronary heart disease patients enrolled in this study. According to clinical manifestation, electrocardiography and the levels of biochemical markers of myocardial necrosis, they were classified into3groups: stable angina group(SA, n=23), unstable angina group(UA, n=28)and acute myocardial infarction group(AMI, n=31).82subjects who underwent coronary angiography and calculated Gensini score. We compared these groups with20cases gender-matched cases who complained of chest pain and with negative CAG result. CAS group was divided into single-vessel(n=22), double-vessel(n=31)and triple-vessel group(n=29). Group n=8cases, the circumflex branch of anterior descending artery lesions n=5cases of the disease Group and the group n=8cases of right coronary artery lesions. Coronary angiography and good leave from the peripheral venous blood samples before analysis of the enzyme-linked immunosorbent assay method for the determination of plasma levels of NT-proBNP. All data processing were done using SPSS17.0statistical package. Measurement data expressed using mean±standard deviation, the two groups were compared using the t-test, multi-group comparison done using analysis of variance. Gensini and NT-proBNP level score, the level of cTnI and TIMI bleeding score between relevant inspection, Analysis of Selecting Spearman correlation coefficient. P<0.05differences have a significant mean.Results:1. The level of NT-proBNP was significantly higher in AMI groups than in other three groups(P<0.05), and was marked higher in UA than in SA Por control(P<0.05), also was higher in SA than in control groups(P<0.05).2. Among patients AHD, plasma NT-proBNP concentrations in patients with three-vessel was higher than those of patients with two-vessel and single vessle, P<0.05. P<0.01.3. In AMI group had a significant correlation between the level of NT-proBNP and troponin I(cTnI)(r=0.895, p<0.01).4. Plasma NT-proBNP concentrations in patients with left anterior descending coronary artery(LAD) was higher than those of patients with right coronary artery(RCA) and left circumflex coronary artery (LCX). P<0.01.5. With the comparison and analysis between the level of NT-proBNP and Gensini Score (r=0.963, p<0.01), we found the level of NT-proBNP tended to increase with the aggravation of coronary artery stenosis. TIMI flow showed a signal ficant negative correlation with plasma NT-proBNP levels(r=-0.39, P<0.01).Conclusion:1. Plasma NT-proBNP significantly increased in patients with coronary heart disease, prompting level of plasma NT-proBNP can be used to predict the severity of myocardial ischemia.2. Support the greater the number of coronary artery lesion, vascular the more important crimes, the higher the level of plasma NT-proBNP, prompting level of plasma NT-proBNP can be used to predict the severity of coronary artery disease.3. NT-proBNP levels in patients with acute myocardial infarction associated with the level of cTnI clearly working, prompting level of plasma NT-proBNP as a severity prediction of myocardial ischemia.4. The level of plasma NT-proBNP and Gensini score is positive, and TIMI bleeding score is negative, the more obvious tips NT-proBNP rise, the more severe myocardial ischemia.5. The levels of Plasma NT-proBNP have some value on risk assessment in patients with coronary heart disease.更多还原