不稳定型心绞痛伴左心收缩功能不全患者Pro-BNP、Hcy、ESR表达及临床意义

doi:10.3969/j.issn.1000-8535.2017.05.007

摘要/Abstract

摘要： 目的探讨不稳定型心绞痛伴左心收缩功能不全患者血清脑钠肽前体(Pro-BNP)、同型半胱氨酸(Hcy) 和血沉(ESR)的表达与临床意义。方法选取2015年1月—2016年10月于广州市第一人民医院心血管内科就诊的130例不稳定型心绞痛(A组) 、130例不稳定型心绞痛伴左心收缩功能不全(B组)患者作为研究对象,同时选取同期130例健康体检者(C组)作为对照。分别检测3组受试者的血清Pro-BNP、Hcy、ESR水平,并用方差分析对3组血清水平进行比较;通过Pearson相关分析比较B组患者的血清Pro-BNP、Hcy和ESR水平与左心室射血分数(LVEF)的相关性。结果不稳定型心绞痛患者和不稳定型心绞痛伴左心收缩功能不全患者的Pro-BNP、Hcy、ESR水平均明显高于对照组,不稳定型心绞痛伴左心收缩功能不全患者的Pro-BNP、Hcy、ESR水平明显高于不稳定型心绞痛患者血清水平。随着心功能分级的升高,患者的血清Pro-BNP、Hcy和ESR水平呈明显上升趋势。血清Pro-BNP、Hcy、ESR水平与 LVEF 呈负相关,血清 Hcy、ESR水平与Pro-BNP水平呈正相关。结论不稳定型心绞痛伴左心收缩功能不全患者血清Pro-BNP、Hcy、ESR水平与心功能分级明显相关,可作为不稳定型心绞痛伴左心收缩功能不全病情评估及预后判断的重要指标。

关键词: 不稳定型心绞痛, 左心收缩功能不全, 脑钠肽前体, 同型半胱氨酸, 血沉

Abstract: Objective To investigate the expressions and clinical significances of atrial brain natriuretic peptide precursor (PRO-BNP), homocysteine (Hcy) and erythrocyte sedimentation rate (ESR) in patients with unstable angina pectoris associated by Left ventricular systolic insufficiency. Methods A total of 130 patients with simple unstable angina pectoris and another 130 patients with unstable angina pectoris associated by left ventricular systolic insufficiency treated during January 2015 and October 2016 were selected as group A and group B respectively,and at the same period,130 healthy persons taking medical examination were selected as the control froup (group C). Serum levels of PRO-BNP,Hcy and ESR were detected in three groups,and the correlation between serums PRO-BNP,Hcy and ESR and left ventricular ejection fraction (LVEF) in group B were analyzed. Results Serum levels of in group A and B were significantly higher than those in group C,and the levels in group B were significantly higher than those in group A. In group B,serum levels of PRO-BNP,Hcy and ESR were significantly increased with rising cardiac function classification. Serum levels of PRO-BNP,Hcy and ESR in group B were negatively correlated with LVEF,but serum levels of Hcy and ESR were positively correlated with PRO-BNP level. Conclusion Serum levels of PRO-BNP,Hcy and ESR in group A and B are significantly correlated with cardiac function in patients with unstable angina pectoris associated by left ventricular systolic insufficiency,so the levels may be used as important indexes for evaluating the severity and prognosis of with unstable angina pectoris associated by left ventricular systolic insufficiency.

Key words: Unstable angina pectoris, Left ventricular systolic insufficiency, Atrial brain natriuretic peptide precursor, Homocysteine, Erythrocyte sedimentation rate

赵斌, 潘艺朝, 李维杰, 雷晓明. 不稳定型心绞痛伴左心收缩功能不全患者Pro-BNP、Hcy、ESR表达及临床意义[J]. 广州医药, 2017, 48(5): 28-31.

ZHAO Bin, PAN Yichao, LI Weijie, LEI Xiaoming. Expressions and clinical significances of Pro-bnp,Hcy and Esr in patients with unstable angina pectoris associated by left ventricular systolic insufficiency[J]. Guangzhou Medical Journal, 2017, 48(5): 28-31.

参考文献

[1] 刘洋. 临床药师对不稳定型心绞痛伴高血压患者的用药分析及药学监护[J]. 中国医药科学, 2016,6(6): 226-228.
[2] 赵碧琼,李莉,田美荣,等.低剂量多巴酚丁胺超声负荷试验与低剂量多巴酚丁胺左心室造影对不稳定型心绞痛并发心功能不全患者存活心肌检测的对比研究[J]. 中国煤炭工业医学杂志, 2005,8(6): 591-592.
[3] 戴倩,王俊. 不稳定型心绞痛治疗进展[J]. 疑难病杂志, 2007(8): 505-508.
[4] 曹振华,党群,杨士强,等. 高敏C反应蛋白、同型半胱氨酸和不稳定型心绞痛患者冠脉病变程度的相关性研究[J]. 中国分子心脏病学杂志, 2013,13(1): 405-407.
[5] 刘科彤, 王新,赵迪.冠脉介入治疗对不稳定型心绞痛患者炎症因子及cTnI、MMP-9、NT-pro BNP的影响[J]. 海南医学院学报, 2016,22(10): 951-956.
[6] 曹龙翎,陈之毅,吴华美,等, 同型半胱氨酸检测在心血管疾病中的应用探讨[J]. 重庆医学, 2013(16): 1833-1834.
[7] 刘程光.介入治疗对冠心病合并左心功能不全患者心功能的影响[J]. 吉林医学, 2016(4): 854-855.
[8] KAMPAKTSIS P N, ULLAL A V, MINUTELLO R M,et al. Impact of paravalvular aortic insufficiency on left ventricular remodeling and mortality after transcatheter aortic valve replacement[J]. J Heart Valve Dis, 2016, 25(3): 301-308.
[9] 陈永强,梁海燕,刘嘉丽,等. hs-CRP与NT-proBNP联合测定指导急性冠脉综合征临床诊疗的价值研究[J]. 中国实用医药, 2016,11(13): 37-38.
[10] 韩晓曼,林国平,王雪臣,等.冠脉宁通方对不稳定型心绞痛近期危险事件预防作用的临床观察30例[J]. 中医临床研究, 2016,8(9): 30-35.
[11] 吕彬. N末端B型脑钠肽(NT-proBNP)检测在老年心力衰竭诊断中的应用研究[J]. 中国医药科学, 2016,6(24): 181-183.
[12] WAKU S,LIDA N,ISHIHARA T. Significance of brain natriuretic peptide measurement as a diagnostic indicator of cardiac function[J]. Methods Inf Med, 2000,39(3): 249-253.
[13] 马维冬,郭旗,贾珊,等.血清proBNP诊断冠心病的价值[J]. 心脏杂志, 2016(3): 289-292.
[14] 符明昌,周莲,羊文芳,等.血清NT-proBNP、hs-TnT及hs-CRP水平与急性心肌梗死的相关性研究[J]. 海南医学, 2016,27(18): 2952-2955.
[15] BOZKURT E,EROL M K,KELES S,et al. Relation of plasma homocysteine levels to intracoronary thrombus in unstable angina pectoris and in non-Q-wave acute myocardial infarction[J]. Am J Cardiol, 2002,90(4): 413-415.
[16] STRAUSS E,SUPIHSKI W, GŁUSZEK J,et al. In patients with coronary artery disease and left ventricular contractile insufficiency the pathogenicity of smoking associates with imbalance in metabolism of homocysteine [J]. Przegl Lek, 2006, 63(10): 951-956.
[17] 景冬樱,王树人,杨志梅,等. 同型半胱氨酸对内皮细胞及脂质过氧化的影响[J]. 中国动脉硬化杂志, 1999,7(2): 128-132.
[18] 霍光,李中言.同型半胱氨酸对血管平滑肌细胞脂质过氧化的影响[J]. 岭南心血管病杂志, 2004,10(4): 297-298.
[19] 张晓梅,王家平.不稳定型心绞痛患者血C-反应蛋白血沉和白细胞联合测定的意义[J]. 江苏大学学报(医学版), 2003(5): 23-24.
[20] 王奇志, 戚秀卿,徐文渊.不稳定型心绞痛与血纤维蛋白原、C反应蛋白和血沉的关系[J]. 同济大学学报(医学版), 2001,22(3): 55-56.
[21] 凌峰,李佩璋.影响心力衰竭患者血沉因素的探讨[J]. 浙江医学, 1996(3): 31-32.