STEMI患者血浆BNP、同型半胱氨酸水平与心肌损伤标记物及冠脉病变程度的相关性  

Correlation of plasma levels of B-type natriuretic peptide and homocysteine with markers of myocardial injury and degree of coronary lesions in patients with STEMI

作　　者：马芳涛 张小玲 MA Fangtao ZHANG Xiaoling(Anhui Provincial Hospital, Hefei 230001, China)

机构地区：[1]安徽医科大学附属省立医院,合肥230001

出　　处：《山东医药》2017年第33期12-15,共4页Shandong Medical Journal

基　　金：安徽省科技厅年度重点科研项目(12020503078)

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者血浆脑钠尿肽(BNP)、同型半胱氨酸(Hcy)水平与心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)浓度、冠脉病变程度以及心功能之间的相关性。方法选取急性STEMI患者176例,根据血浆BNP峰值水平检测结果将其分为A组(BNP<100 pg/m L)71例、B组(100 pg/m L≤BNP<500 pg/m L)63例及C组(BNP≥500 pg/m L)42例。检测三组血浆BNP、Hcy、cTnI、CK-MB水平、冠脉病变程度及心脏结构功能并进行对比分析。结果 A、B、C组血浆cTnI、CK-MB、BNP、Hcy均依次升高,左心室射血分数(LVEF)均依次降低,左室舒张末压力(LVEDP)依次升高,组间比较差异有统计学意义(P均<0.05);三组Killip分级、病变血管种类、病变血管类型、病变冠脉积分、侧支循环形成及TIMI血流分级相比较有统计学意义(P均<0.05)。Spearman相关性分析显示,血浆BNP水平与cTnI、CK-MB水平、病更冠脉积分以及LVEDP呈正相关(r依次为0.702、0.738、0.696、0.483,P均<0.05),与LVEF呈负相关(r=-0.655,P<0.05);血浆Hcy水平与cTnI、CK-MB水平、病变冠脉积分以及LVEDP呈正相关(r依次为0.681、0.716、0.613、0.545,P均<0.05),与LVEF呈负相关(r=-0.626,P<0.05)。Logistic回归分析显示,吸烟、高血压、糖尿病、血脂异常、LVEF降低以及血浆cTnI、BNP、Hcy水平升高是急性STEMI发生的独立危险因素。结论急性STEMI患者血浆BNP、Hcy水平升高,心肌损伤标记物水平亦升高,提示冠脉病变程度明显加重且心功能变差。Objective To investigate the correlations of B-type natriuretic peptide（ BNP） and homocysteine（ Hcy）levels with cardiac troponin I（ cTnI）,creatine kinase MB（ CK-MB） concentration,degree of coronary lesions,and cardiac function in patients with acute ST-segment elevation myocardial infarction（ STEMI）. Methods Totally 176 patients with acute STEMI were selected. According to the results of plasma BNP peak detection,they were divided into the group A（ BNP 100 pg/m L,71 cases）,group B（ 100 pg/m L≤BNP 500 pg/m L,63 cases）,and group C（ BNP≥500 pg/m L,42 cases）. We recorded and compared the plasma levels of BNP,Hcy,and cTnI,CK-MB concentration,degree of coronary lesions,and cardiac function between the three groups. Results The plasma levels of cTnI,CK-MB,BNP,and Hcy in the groups A,B,C gradually increased,left ventricular ejection fraction（ LVEF） gradually decreased,left ventricular end-diastolic pressure（ LVEDP） gradually increased,and the difference between every two groups were significant（ all P〈0. 05）. The differences in the Killip grade,vascular lesions,lesion type,lesion type integral,coronary collateral circulation,and TIMI flow grade between the three groups were statistically significant（ all P〈0. 05）. Spearman correlation analysis showed that the plasma BNP level was positively correlated with cTnI,CK-MB,coronary score,and LVEDP（ r =0. 702,0. 738,0. 696,0. 483,respectively; all P〈0. 05）,and was negatively correlated with LVEF（ r =-0. 655,P〈0. 05）. The plasma Hcy level was positively correlated with cTnI,CK-MB,coronary score,and LVEDP（ r = 0. 681,0. 716,0. 613,0. 545,respectively; all P〈0. 05）,and was negatively correlated with LVEF（ r =-0. 626,P〈0. 05）.Logistic regression analysis showed that smoking,hypertension,diabetes mellitus,dyslipidemia and decreased LVEF,and increased plasma levels of cTnI,BNP,and Hcy were independent risk factors for acute STEMI. Conclusion With the increasing plasma BNP and Hcy levels in patients with a

关 键 词：心肌梗死 ST段抬高型 急性 利钠肽 脑 同型半胱氨酸 心肌标志物 冠脉病变积分 

分 类 号：R542.22[医药卫生—心血管疾病]