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白敏,陈向红,郭照军,陈磊,王超,吴曾繁,王雅纯.血清N末端B型利钠肽原和同型半胱氨酸联合检测对冠状动脉病变的评估价值[J].中国动脉硬化杂志,2019,(3):241~246
血清N末端B型利钠肽原和同型半胱氨酸联合检测对冠状动脉病变的评估价值
Evaluation value of combined detection of serum N-terminal pro-B-type natriuretic peptide and homocysteine for coronary artery disease
投稿时间:2018-01-22  修订日期:2018-05-09
DOI:
中文关键词:  N末端B型利钠肽原  同型半胱氨酸  冠心病  评估价值
英文关键词:N-terminal pro-B-type natriuretic peptide  homocysteine  coronary heart disease  evaluation value
基金项目:
作者单位E-mail
白敏 海南医学院第二附属医院心血管内科,海南省海口市 570311 e-mail为baimin78@163.com 
陈向红 海南医学院第二附属医院心血管内科,海南省海口市 570311  
郭照军 海南医学院第二附属医院心血管内科,海南省海口市 570311  
陈磊 海南医学院第二附属医院心血管内科,海南省海口市 570311  
王超 海南医学院第二附属医院心血管内科,海南省海口市 570311  
吴曾繁 海南医学院第二附属医院心血管内科,海南省海口市 570311  
王雅纯 海南医学院第一附属医院老年科,海南省海口市 570102  
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中文摘要:
      目的 探讨血清N末端B型利钠肽原(NT-proBNP)和同型半胱氨酸(Hcy)联合检测评估冠心病患者冠状动脉斑块性状的价值及相关程度。方法 188例冠心病患者按照临床分型分为2组:稳定型心绞痛(SAP)组(n=106)、急性冠状动脉综合征(ACS)组(n=82);选择同时期接受冠状动脉造影检查结果正常者为对照组(n=90)。测定血清NT-proBNP、Hcy及高敏C反应蛋白(hs-CRP)水平。根据冠状动脉造影结果计算Gensini积分;采用血管内超声检测斑块成分指标。应用Pearson相关分析NT-proBNP、Hcy水平与Gensini积分及斑块成分指标的相关性。应用Logistic回归分析NT-proBNP、Hcy水平与易损性斑块的关系。应用受试者工作特征(ROC)曲线下面积(AUC)分析NT-proBNP、Hcy预测易损性斑块的价值。结果 3组间NT-proBNP、Hcy与hs-CRP浓度均存在显著差异(P<0.05),且均为ACS组>SAP组>对照组(均P<0.05)。ACS组Gensini积分、坏死核心(NC)比例、血管重塑指数(VRI)、斑块偏心指数(PEI)均显著高于SAP组(P<0.05)。NT-proBNP、Hcy水平与Gensini积分及斑块NC比例、VRI、PEI呈正相关(均P<0.05)。多元Logistic回归分析显示,NT-proBNP、Hcy血清水平是冠心病患者易损性斑块的独立危险因素(均P<0.05)。NT-proBNP、Hcy预测冠状动脉易损性斑块的AUC分别为0.764(95%CI 0.729~0.803,P=0.021)、0.779(95%CI 0.742~0.814,P=0.015);两者联合预测冠状动脉易损性斑块的AUC为0.886(95%CI 0.823~0.951,P=0.004)。结论 血清NT-proBNP、Hcy联合检测可有效评估冠心病患者冠状动脉斑块病变性状。
英文摘要:
      Aim To evaluate the value and correlation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and homocysteine (Hcy) combined detection for coronary atherosclerotic plaque in patients with coronary heart disease (CHD). Methods According to clinical classification, 188 patients with CHD were divided into 2 groups:stable angina pectoris (SAP) group (n=106), acute coronary syndrome (ACS) group (n=82); Those who had normal coronary angiography at the same time were selected as control group (n=90). Serum levels of NT-proBNP, Hcy and high-sensitivity C-reactive protein (hs-CRP) were measured. According to the results of coronary angiography, Gensini score was calculated. Plaque component index was detected by intravascular ultrasound. Correlations between NT-proBNP, Hcy levels and Gensini score, plaque composition index were analyzed by Pearson correlation analysis. Relationship between NT-proBNP, Hcy levels and vulnerable plaques was analyzed by Logistic regression analysis. The values of NT-proBNP and Hcy in predicting vulnerable plaques were evaluated by the receiver operating characteristic (ROC) curve area under curve (AUC). Results There were significant differences in the concentrations of NT-proBNP, Hcy and hs-CRP among the 3 groups (P<0.05), and all of them were ACS group>SAP group>control group (P<0.05). The Gensini score, the ratio of necrotic core (NC), vascular remodeling index (VRI) and plaque eccentricity index (PEI) in group ACS were significantly higher than those in SAP group (P<0.05). The levels of NT-proBNP and Hcy were positively correlated with Gensini score and plaque NC ratio, VRI and PEI (all P<0.05). Multivariate Logistic regression analysis showed that serum NT-proBNP and Hcy levels were independent risk factors for vulnerable plaques in patients with CHD (all P<0.05). The AUC values of NT-proBNP and Hcy in predicting coronary vulnerable plaques were 0.764 (95%CI 0.729~0.803, P=0.021), 0.779 (95%CI 0.742~0.814, P=0.015). When NT-proBNP and Hcy were combined, the AUC of predicting coronary vulnerable plaques was 0.886 (95%CI 0.823~0.951, P=0.004). Conclusion Combined detection of serum NT-proBNP and Hcy can effectively assess coronary atherosclerotic plaques in patients with CHD.
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