【作者】 刘旭东；

【导师】 胡厚源；

【作者基本信息】 第三军医大学 ， 内科学， 2006， 硕士

【摘要】 【研究目的】探讨和评价血清hsCRP水平在筛选心血管病高危患者中的作用；了解高血压患者血管内皮依赖性舒张功能的变化及相关影响因素。【研究方法】2004年10月至2006年3月，因心血管疾病入住我院心内科的患者共216例，其中男152例，女64例，平均年龄48.6±18.4(31～83)岁。按临床表现分为：①高危心血管病组(high risk patient group，HRP)：共68例(男49例、女19例)，平均年龄50.2±18.7岁，包括急性冠状动脉综合征(ACS)和急性主动脉夹层动脉瘤(ADA)患者；②低危心血管病组(low risk patient group，LRP)：共82例(男59例、女23例)，平均年龄49.1±18.1岁，包括单纯轻中度高血压、稳定性心绞痛患者：③对照组(Control group)：共66例(男44例，女22例)，平均年龄46.6±15.7岁，为同期因阵发性室上性心动过速(PSVT)或心悸／胸闷(出院诊断为“心脏神经官能症”者)入院，且已排除其他心血管疾病的患者；比较三组患者血清hsCRP水平。另于2005年3月至2006年3月入选62例因原发性高血压入院的中青年患者，其中男55例，女7例，平均年龄44.97±8.20(29～65)岁。根据患者血压水平、肥胖情况、阻塞性睡眠呼吸暂停综合征(OSAS)的严重程度等检测指标进行分组，以肱动脉超声研究血管内皮依赖性舒张功能(EDD)的变化及相关影响因素。【研究结果】①HRP组与LRP组患者血清hsCRP水平均显著高于对照组；以急性冠状动脉综合征(ACS)为主的HRP组，其血清hsCRP水平非常显著的高于LRP组(p＜0.01)；以血清hsCRP＞3.0mg／L为判定高危心血管病患者的标准时，其敏感性和特异性均在75％左右；对照组和LRP组的血清CK-MB或cTnI水平均在正常范围内，ACS患者血清hsCRP水平与CK-MB或cTnI水平无明显相关性。②重度高血压患者的血管内皮依赖性舒张功能有显著下降(p＜0.01)，其他影响血管内皮依赖性舒张功能的主要因素还有中心性肥胖(p＜0.01)和睡眠呼吸暂停综合征(p＜0.05)。【研究结论】①HRP组血清hsCRP水平非常显著的高于LRP组(p＜0.01)，以血清hsCRP＞3.0mg／L为高危心血管病患者的判定标准时，具有较好的敏感性和特异性，但临床诊断须结合其它相关资料。②高血压患者血管内皮依赖性舒张功能的下降可能是血管损伤的早期表现，中心性肥胖及睡眠呼吸暂停综合征也可能是重要的影响因素。更多还原

【Abstract】 Objective To evaluate the level of serum high-sensitivity C-reactive protein (hsCRP)as an important indicator for early risk stratification in patients with an acute coronarysyndrome (ACS) or other high risk vascular disease. To observe the changes ofendothelium dependent diastolic function in patients with hypertension and otherinfluencing factors (such as obesity and obstructive sleep apnea syndrome).Methods In 216 consecutive patients, the level of serum hsCRP were analyzed.Include 152 male and 64 female, mean age 48.64±18.4 (31-83)yr. According to the clinicalmanifestation, the patients were divided into three groups:①High risk patient group(HRP), 68 patients (49 male and 19 female), mean age 50.2±18.7 yr, include acute coronarysyndrome (ACS) and aortic dissecting aneurysm (ADA);②Low risk patient group (LRP),82 patients (59 male and 23 female), mean age 49.1±18.1 yr, include essential hypertension(BP＜180/110mmHg) and stable angia pectoris;③Control group, 66 patients (44 male and22 female) without vascular disease, mean age 46.6±15.7yr. The 62 consecutive young andmiddle-aged patients with essential hypertension in which some from LRP group, 55 maleand 7 female, mean age 44.97±8.20 (29-65) yr. The group were divided by the bloodpressure level, degree of obesity or obstructive sleep apnea syndrome (OSAS). The highresolution ultrasound was applied to measure brachial artery flow-mediated endothelium-dependent dilation and glyceryhrinitrate (GNT) -mediated endothelium-independent dilation.Results①Compared with the control group (0.37±0.25mg/L), the serum hsCRPlevels in both of LRP group (1.28±0.79 mg/L, p＜0.05) and HRP group (5.82±3.94 mg/L,p＜0.01) were significantly increased; the level of serum hsCRP in HRP group was alsosignificantly higher than that in LRP group (p＜0.01). The cutoff values were 3.0mg/L forserum hsCRP, its sensitivity and specificity for patients with high risk cardiovasculardisease (especially ACS or ADA) were 73.53% and 75.36% respectively; the false positiverate is 11.49%, and the false negative rate is 26.47%. The levels of serum CK-MB (cutoff value 25IU/L) and cTnl (cutoff value 0.1μg/L) in control and LRP groups are normal. Theserum levels of CK-MB and cTnI are not related to the hsCRP level.②The endotheliumdependent diastolic function (EDD) in severe hypertension group (BP≥180/110mmHg) wasdecreased significantly versus the mild hypertension group (p＜0.01). Central-type obesityand OSAS could also affect EDD obviously.Conclusion①The level of serum hsCRP in HRP group was obviously higher thanother groups. The 3.0 mg/L serum hsCRP as cutoff value is useful for identifying thepatients with ACS or ADA. But the final diagnosis should be made by combination withother important clinical data.②The decrease of endothelium dependent diastolic function(EDD) in hypertension may be an early appearance of the damage in arterial wall.Central-type obesity and OSAS may also influence EDD as important factors.更多还原