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目的探讨氨基末端B型钠尿肽原(NT-proBNP)、心型脂肪酸结合蛋白(HFABP)和肌钙蛋白I(cTnI)在不同病变程度冠心病(CHD)中的表达特性及临床意义。方法将582例CHD患者按病情严重程度分为无症状心肌缺血(SMI)组(142例)、稳定心绞痛组(SAP)(151例)、不稳定心绞痛组(UAP)(155例)、急性心肌梗死组(AMI)(134例)。采用双向侧流免疫法检测582例CHD患者及80名健康对照者血清NT-proBNP、HFABP和cTnI水平,并进行统计学分析。结果不同病变程度CHD组血清NT-proBNP水平及阳性率明显高于对照组(P<0.01),随冠脉病变程度加重,NTproBNP水平及阳性率逐渐升高,各组差异均有统计学意义(P<0.01)。AMI组HFABP和cTnI水平及阳性率明显高于UAP组(P<0.01),UAP组明显高于SAP组(P<0.01),SAP组和SMI组与对照组HFABP和cTnI水平差异无统计学意义(P>0.05),且2组HFABP和cTnI阳性率均为0。SAP组和SMI组NT-proBNP阳性率明显高于HFABP和cTnI阳性率(P<0.01),UAP组NT-proBNP和HFABP阳性率明显高于cTnI阳性率(P<0.01)。根据ROC曲线选取NT-proBNP为317.23和725.40 ng/L作为SMI和SAP诊断的临界值;选取NT-proBNP、H-FABP和cTnI分别为2 125.40 ng/L、7.86 ng/L和0.085 ng/L及3 984.21 ng/L、14.75 ng/L、1.98 ng/L作为诊断UAP和AMI临界值,可获最佳诊断价值。结论血清NT-proBNP、HFABP和cTnI在不同病变程度CHD中有不同的表达特性,联合检测NT-proBNP、HFABP和cTnI对不同病变程度CHD诊断及CHD分型有重要临床价值。
Objective To investigate the expression and clinical significance of NT-proBNP, HFABP and cTnI in patients with coronary heart disease (CHD) with different pathological changes. Methods Fifty-two patients with CHD were divided into two groups: silent asymptomatic myocardial ischemia (142 cases), stable angina (SAP) (151 cases), unstable angina (UAP) (155 cases), acute Myocardial infarction group (AMI) (134 cases). Serum levels of NT-proBNP, HFABP and cTnI in 582 CHD patients and 80 healthy controls were detected by two-sided lateral flow immunoassay and statistically analyzed. Results The serum NT-proBNP level and positive rate in CHD group were significantly higher than those in control group (P <0.01). With the severity of coronary artery disease, the level of NTproBNP and the positive rate of NTproBNP increased gradually (all P <0.01) P <0.01). The levels and positive rates of HFABP and cTnI in AMI group were significantly higher than those in UAP group (P <0.01), but those in UAP group were significantly higher than those in SAP group (P <0.01). There was no significant difference in HFABP and cTnI between SAP group and SMI group (P> 0.05). The positive rates of HFABP and cTnI in two groups were all zero. The positive rates of NT-proBNP in SAP and SMI groups were significantly higher than those in HFABP and cTnI groups (P <0.01). The positive rates of NT-proBNP and HFABP in UAP group were significantly higher than those in cTnI group (P <0.01). NT-proBNP was 317.23 and 725.40 ng / L according to the ROC curve as the critical value for the diagnosis of SMI and SAP. The NT-proBNP, H-FABP and cTnI were 2 125.40 ng / L, 7.86 ng / L and 0.085 ng / L And 3 984.21 ng / L, 14.75 ng / L and 1.98 ng / L, respectively, were the best diagnostic values for the diagnosis of UAP and AMI. Conclusions Serum NT-proBNP, HFABP and cTnI have different expression characteristics in different lesion degree CHD. Combined detection of NT-proBNP, HFABP and cTnI has important clinical value in the diagnosis of CHD and the type of CHD.