[1]高致炳,韩　冬,张　超.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[J].新乡医学院学报,2021,38(9):864-867.[doi:10.7683/xxyxyxb.2021.09.013]
　GAO Zhibing,HAN Dong,ZHANG Chao.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[J].Journal of Xinxiang Medical University,2021,38(9):864-867.[doi:10.7683/xxyxyxb.2021.09.013]
点击复制

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
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年9
页码:
864-867
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
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; 韩　冬; 张　超
（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）
Author(s):
GAO Zhibing; HAN Dong; ZHANG Chao
(Department of Cardiovascular Surgery,Nanyang Central Hospital Affiliated to Zhengzhou University,Nanyang 473009,Henan Province,China)
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
Keywords:
coronary atherosclerotic heart diseaseheart failurebrain natriuretic peptidehigh-sensitivity C-reactive protein
分类号:
R735.1
DOI:
10.7683/xxyxyxb.2021.09.013
文献标志码:
A
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（χ2=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（χ2=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（χ2=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HF的预测价值较高，血浆BNP和hs-CRP水平联合检测可提高诊断CAHD患者并发HF的敏感度。
Abstract:
Objective　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=4.948,4.816P<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 and specificity of plasma hs-CRP in predicting HF in patients with CAHD were 89.4% and 64.4%,the sensitivity and specificity of their combination in predicting HF in patients with CAHD were 97.9% and 60.2%.There was no significant difference in the sensitivity of plasma BNP,hs-CRP and their combination in predicting HF in patients with CAHD(χ2=0.123,0.712,0.260P＞0.05).The specificity of plasma BNP in predicting HF in patients with CAHD was significantly higher than that of plasma hs-CRP and their combination(χ2=51.093,38.991P＜0.05).There was no significant difference in the specificity of plasma hs-CRP and their combination in predicting HF in patients with CAHD(χ2=2.289,P＞0.05).Conclusion　The levels of plasma BNP and hs-CRP in CAHD patients complicated with HF increased significantly,and there is a significant positive correlation between plasma BNP and hs-CRP.The plasma BNP level has a high predictive value for HF in patients with CAHD,and the detection of plasma BNP and hs-CRP levels can improve the sensitivity of diagnosing HF in patients with CAHD.

参考文献/References:

［1］　LI J,LIU F,LIANG F,et al.Long-term effects of high exposure to ambient fine particulate matter on coronary heart disease incidence:a population-based chinese cohort study［J］.Environ Sci Technol,2020,54(11):6812-6821.
［2］　ZHAO M,CHE Q,ZHANG Y,et al.Expression and clinical significance of serum cystatin C in patients with hypertension and coronary heart disease［J］.Medicine (Baltimore),2020,99(22):e20029.
［3］　陈郧，马珍珍，张威，等.动态心电图评价冠状动脉粥样硬化性心脏病患者左心房容积、功能和同步性的价值研究［J］.中国现代医学杂志，2020，30（10）：121-124.
［4］　徐伟华.多层螺旋CT血管造影对冠状动脉粥样硬化性心脏病患者冠脉狭窄程度及斑块稳定性的评价［J］.影像科学与光化学，2020，38（3）：491-495.
［5］　彭春艳，李显东，张训男，等.冠状动脉粥样硬化性心脏病患者循环白细胞SREBP-2启动子甲基化与其他风险因素的相关性研究［J］.中华检验医学杂志，2020，43（2）：191-198.
［6］　JIANG Y,HE Q,ZHANG T,et al.Exploring the mechanism of Shengmai Yin for coronary heart disease based on systematic pharmacology and chemoinformatics［J］.Biosci Rep,2020,40(6):BSR20200286.
［7］　吕英俊，余平，陈奕，等.冠状动脉粥样硬化性心脏病患者血清adropin蛋白与炎性指标水平变化及相关性分析［J］.重庆医学，2019，48（23）：4116-4118.
［8］　ZHAO G,ZHANG H,WANG Y,et al.Effects of levocarnitine on cardiac function,urinary albumin,hs-CRP,BNP,and troponin in patients with coronary heart disease and heart failure［J］.Hellenic J Cardiol,2020,61(2):99-102.
［9］　中华医学会心血管病学分会介入心脏病学组，中华医学会心血管病学分会动脉粥样硬化与冠心病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，等.稳定性冠心病诊断与治疗指南［J］.中华心血管病杂志，2018，46（9）：680-694.
［10］　中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018［J］.中华心血管病杂志，2018，46（10）：760-789.
［11］　陈云玲，吕风华，陈玉磊，等.血清脂联素、C1q/肿瘤坏死因子相关蛋白9与冠状动脉病变程度的关系［J］.新乡医学院学报，2019，36（10）：967-970，974.
［12］　徐宝华，李楠，朱家庭.冠状动脉粥样硬化性心脏病慢性心力衰竭患者血清microRNA-499水平及与心功能 和心肌重构的相关性［J］.中国现代医学杂志，2020，30（2）：104-108.
［13］　张松雨，李纲，李燕，等.稳心颗粒联合倍他乐克对冠状动脉粥样硬化性心脏病心力衰竭合并室性早搏患者血浆N-末端B型利钠肽原水平的影响［J］.中医学报，2018，33（5）：865-869.
［14］　KNIG P,MAYER O,BRUTHANS J,et al.The prognostic importance of subclinical heart failure in stable coronary heart disease patients［J］.Acta Cardiol,2020,75(4):329-336.
［15］　王丹，汪砚雨，刘相勇.冠状动脉粥样硬化性心脏病合并心力衰竭患者血浆Ω-3脂肪酸、超敏C反应蛋白水平及意义［J］.中国现代医学杂志，2017，27（11）：50-53.
［16］　LUO Z,LIU Y,ZHAO Z,et al.Effects of Astragalus injection and Salvia Miltiorrhiza injection on serum inflammatory markers in patients with stable coronary heart disease:a randomized controlled trial protocol［J］.Trials,2020,21(1):267.
［17］　沈志涛.盐酸曲美他嗪片在冠状动脉粥样硬化性心脏病并发心力衰竭患者的应用效果［J］.岭南心血管病杂志，2019，25（6）：606-609.

相似文献/References:

[1]刘建庄,李金兰,娄清云,等.风湿性心脏病心力衰竭血液流变学改变[J].新乡医学院学报,1992,9(02):108.
[2]苗萍,张喜芳 王延枝.硝酸甘油治疗婴幼儿肺炎心衰疗效观察[J].新乡医学院学报,2000,17(02):129.
[3]任明芬,张三强,张冬红,等.冠心病患者QT间期离散度改变的I临床意义[J].新乡医学院学报,2000,17(03):177.
[4]刘　慧,胡永寸,陈　俭,等.卡维地洛对冠心病心力衰竭患者心室重构和心功能的影响[J].新乡医学院学报,2003,20(01):013.
[5]刘 慧,胡永寸,陈俭。杨庆福.卡维地洛对冠心病心力衰竭患者心室重构和心功能的影响[J].新乡医学院学报,2003,20(01):013.
[6]吕风华,张素荣,张跃光,等.冠状动脉粥样硬化性心脏病合并充血性心力衰竭患者血浆脑钠肽水平的检测[J].新乡医学院学报,2007,24(06):581.
[7]廖燕.老年冠状动脉粥样硬化性心脏病患者心功能与肺动脉压和心电指标的关系[J].新乡医学院学报,2012,29(09):696.
[8]郭鹏,李继红.不同类型冠状动脉粥样硬化性心脏病患者血浆D-二聚体和纤维蛋白原水平变化[J].新乡医学院学报,2012,29(09):698.
[9]李永锋,许志强,韩 鹏,等.冠状动脉粥样硬化性心脏病合并阻塞性睡眠呼吸暂停低通气综合征的临床分析 [J].新乡医学院学报,2012,29(10):784.
[10]舒　毅,陈幼萍,曾春平,等. ２型糖尿病合并冠状动脉粥样硬化性心脏病患者下肢血管病变相关因素分析[J].新乡医学院学报,2015,32(08):785.
[11]陶　涛,刘毅龙.重组人脑利钠肽联合沙库巴曲缬沙坦钠片治疗冠状动脉粥样硬化性心脏病心力衰竭疗效观察[J].新乡医学院学报,2022,39(3):258.[doi:10.7683/xxyxyxb.2022.03.012]
　TAO Tao,LIU Yilong.Effect of recombinant human brain natriuretic peptide combined with sacubitril valsartan sodium tablet in the treatment of patients with heart failure caused by coronary atherosclerotic heart disease[J].Journal of Xinxiang Medical University,2022,39(9):258.[doi:10.7683/xxyxyxb.2022.03.012]

更新日期/Last Update: 2021-09-05