冠状动脉粥样硬化性心脏病并发心力衰竭患者血浆脑利钠肽和高敏C反应蛋白水平变化及临床意义  

Clinical significance of the changes of plasma brain natriuretic peptide and high-sensitivity C-reactive protein levels in patients with coronary atherosclerotic heart disease complicated with heart failure

作　　者：高致炳[1] 韩冬[1] 张超[1] GAO Zhibing;HAN Dong;ZHANG Chao(Department of Cardiovascular Surgery,Nanyang Central Hospital Affiliated to Zhengzhou University,Nanyang 473009,Henan Province,China)

机构地区：[1]南阳市中心医院/郑州大学附属南阳中心医院心脏大血管外科,河南南阳473009

出　　处：《新乡医学院学报》2021年第9期864-867,共4页Journal of Xinxiang Medical University

摘　　要：目的探讨冠状动脉粥样硬化性心脏病(CAHD)并发心力衰竭(HF)患者血浆脑利钠肽(BNP)和高敏C反应蛋白(hs-CRP)水平变化,并分析二者对CAHD患者并发HF的预测价值。方法选择2018年6月至2020年3月南阳市中心医院收治的105例CAHD患者为研究对象,根据是否并发HF将患者分为CAHD组(n=58)和CAHD+HF组(n=47),另选择同期体检健康者60例为健康对照组。检测并比较3组受试者血浆BNP、hs-CRP水平,采用Pearson相关性分析血浆BNP、hs-CRP水平关系,并建立受试者工作特征(ROC)曲线,分析血浆BNP、hs-CRP对CAHD患者并发HF的预测价值。结果CAHD+HF组和CAHD组患者血浆BNP、hs-CRP水平显著高于健康对照组(P<0.05),CAHD+HF组患者血浆BNP、hs-CRP水平显著高于CAHD组(P<0.05)。Pearson相关性分析显示,血浆BNP与hs-CRP水平呈显著正相关(r=0.716,P<0.05)。ROC曲线结果显示,血浆BNP、hs-CRP及二者联合检测预测CAHD患者并发HF的曲线下面积(AUC)分别为0.955、0.788、0.975;血浆BNP及二者联合检测预测CAHD患者并发HF的AUC显著大于血浆hs-CRP(Z=4.948、4.816,P<0.05);血浆BNP与二者联合检测预测CAHD患者并发HF的AUC比较差异无统计学意义(Z=1.903,P>0.05)。以血浆BNP 274.465 ng·L^(-1)、hs-CRP 4.000 mg·L^(-1)为最佳截断值,血浆BNP预测CAHD并发HF的敏感度和特异度分别为91.5%、100.0%,血浆hs-CRP预测CAHD并发HF的敏感度和特异度分别为89.4%、64.4%,二者联合预测CAHD并发HF的敏感度和特异度分别为97.9%、60.2%;血浆BNP、hs-CRP及二者联合预测CAHD并发HF的敏感度比较差异无统计学意义(χ^(2)=0.123、0.712、0.260,P>0.05),血浆BNP预测CAHD并发HF的特异度显著高于血浆hs-CRP及二者联合(χ^(2)=51.093、38.991,P<0.05),血浆hs-CRP与二者联合预测CAHD并发HF的特异度比较差异无统计学意义(χ^(2)=2.289,P>0.05)。结论CAHD并发HF患者血浆BNP、hs-CRP水平显著升高,血浆BNP与hs-CRP水平呈显著正相关;血浆BNP水平对CAHD患者并发HFObjective To investigate the changes of plasma brain natriuretic peptide(BNP)and high-sensitivity C-rea-ctive protein(hs-CRP)levels in patients with coronary atherosclerotic heart disease(CAHD)complicated with heart failure(HF),and to analyze their predictive value for HF in CAHD patients.Methods A total of 105 patients with CAHD admitted in Nanyang Central Hospital from June 2018 to March 2020 were selected as the research subjects.The patients were divided into CAHD group(n=58)and CAHD+HF group(n=47)according to whether they were complicated with HF.Sixty healthy persons were selected as the healthy control group in the same period.The levels of plasma BNP and hs-CRP were detected and compared in the three groups.The relationship between plasma BNP and hs-CRP levels was analyzed by Pearson correlation.The predictive value of plasma BNP and hs-CRP for HF in CAHD patients was analyzed by receiver operating cha-racteristic(ROC)curve.Results The levels of plasma BNP and hs-CRP in the CAHD+HF group and CAHD group were significantly higher than those in the healthy control group(P<0.05).The levels of plasma BNP and hs-CRP in the CAHD+HF group were significantly higher than those in the CAHD group(P<0.05).Pearson correlation analysis showed that there was a significant positive correlation between plasma BNP and hs-CRP levels(r=0.716,P<0.05).ROC curve showed that the area under the curve(AUC)of plasma BNP,hs-CRP and their combination in predicting HF in patients with CAHD was 0.955,0.788 and 0.975,respectively.The AUC of plasma BNP and their combination in predicting HF in patients with CAHD was significantly greater than that of plasma hs-CRP(Z=4.948,4.816;P<0.05).There was no significant difference in the AUC between plasma BNP and their combination in predicting HF in patients with CAHD(Z=1.903,P>0.05).Taking plasma BNP 274.465 ng·L^(-1) and hs-CRP 4.000 mg·L^(-1) as the best cut-off values,the sensitivity and specificity of plasma BNP in predicting HF in patients with CAHD were 91.5%and 100.0%,the sensitivity an

关 键 词：冠状动脉粥样硬化性心脏病 心力衰竭 脑利钠肽 高敏C反应蛋白 

分 类 号：R735.1[医药卫生—肿瘤]