黄通等

[摘要] 目的 探讨N末端脑钠素原（NT-proBNP）水平与冠心病患者危险分层及全球急性冠状动脉事件注册（GRACE）评分的相关性。 方法 回顾性分析2013年1月～2014年4月在深圳市南山区慢性病防治院行冠状动脉造影检查的冠心病患者231例的临床资料，根据患者的冠状动脉狭窄情况以及临床症状和体征分为对照组（57例）、稳定型心绞痛组（95例）、急性冠脉综合征组（79例）。冠心病危险分层：GRACE评分<108分为低危（119例）；GRACE评分109～140分为中危（74例）；GRACE评分>140分为高危（38例）。所有患者检测NT-proBNP水平，分析NT-proBNP与危险分层以及GRACE评分的关系。采用统计学软件InStat 3.06进行数据的分析和处理。 结果 对照组、稳定型心绞痛组和急性冠脉综合征组的NT-proBNP水平分别为（336.1±117.9）、（814.5±279.4）、（3174.2±416.8）pg/mL；急性冠脉综合征组显著高于对照组和稳定型心绞痛组，稳定型心绞痛组显著高于对照组（均P < 0.01）。对照组、稳定型心绞痛组和急性冠脉综合征组的GRACE评分分别为（98.9±16.1）、（109.4±16.9）、（125.5±18.7）分；急性冠脉综合征组显著高于对照组和稳定型心绞痛组，稳定型心绞痛组显著高于对照组（均P < 0.01）。低危、中危及高危的NT-proBNP水平分别为（833.1±218.5）、（1242.6±407.3）、（4152.3±601.6）pg/mL；高危显著高于中危和低危，中危显著高于低危（均P < 0.01）。冠心病患者外周血NT-proBNP水平与GRACE评分呈正相关（r = 0.401，P < 0.01）。 结论 冠心病患者NT-proBNP水平与病情、危险分层等有相关性。

[关键词] 冠心病；N末端脑钠素原；全球急性冠状动脉事件注册

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2015）06（b）-0068-04

Correlation of N-terminal pro-brain natriuretic peptide level with risk stratification and global registry of acute coronary event score in patients with coronary heart disease

HUANG Tong1 LUO Zhongxing2 ZHOU Hua1 LIU Zhihui1 QIN Jie2

1.Health Service Center， Chronic Disease Prevention and Treatment Hospital of Nanshan District in Shenzhen City， Guangdong Province， Shenzhen 518054， China； 2.Department of Radiology， the Third Affiliated Hospital of Sun Yat-sen University， Guangdong Province， Guangzhou 510630， China

[Abstract] Objective To discuss correlation of N-terminal pro-brain natriuretic peptide （NT-proBNP） level with risk stratification and global registry of acute coronary event （GRACE） score in patients with coronary heart disease. Methods Clinical data of 231 cases with coronary artery disease underwent coronary angiography in Chronic Disease Prevention and Treatment Hospital of Nanshan District in Shenzhen City from January 2013 to April 2014 were retrospectively analyzed. All patients were divided into control group （57 cases）， stable angina group （95 cases） and acute coronary syndrome group （79 cases） according to coronary stenosis， clinical signs and symptoms of patients. Risk stratification of coronary heart disease： GRACE score < 108 as low risk （119 cases）； GRACE score from 109 to 140 as moderate risk （74 cases）； GRACE score > 140 as high risk （38 cases）. NT-proBNP levels of all patients were detected， and correlation of NT-proBNP level with risk stratification and GRACE score in patients with coronary heart disease was analyzed. The data were analyzed by the statistical software InStat 3.06. Results NT-proBNP level of control group， stable angina group and acute coronary syndrome group was （336.1±117.9）， （814.5±279.4）， （3174.2±416.8） pg/mL respectively. NT-proBNP level of acute coronary syndrome group was apparently higher than that of control group and stable angina group respectively， stable angina group was apparently higher than that control group （all P < 0.01）. GRACE score of control group， stable angina group and acute coronary syndrome group was （98.9±16.1）， （109.4±16.9） （125.5±18.7） scores respectively. GRACE score of acute coronary syndrome group was apparently higher than that of control group and stable angina group respectively， stable angina group was apparently higher than that control group （all P < 0.01）. NT-proBNP level of low risk， moderate risk and high risk was （833.1±218.5）， （1242.6±407.3）， （4152.3±601.6） pg/mL respectively. NT-proBNP level of high risk was apparently higher than that of moderate risk and low risk respectively， moderate risk was apparently higher than that of low risk （all P < 0.01）. NT-proBNP levels in patients with coronary artery disease showed a positive relationship with GRACE score （r = 0.401， P < 0.01）. Conclusion NT-proBNP levels in patients with coronary artery disease have correlation with severity and risk stratification.

[Key words] Coronary heart disease； NT-proBNP； GRACE

N末端脑钠素原（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平变化可用于监测左室功能不全的治疗效果和评价血管重塑性[1-4]。研究显示，NT-proBNP水平与冠心病的严重程度有相关性。全球急性冠状动脉事件注册（global registry of acute coronary event，GRACE）评分能够有效预测急性冠脉综合征的死亡风险。本研究回顾性分析231例行冠状动脉造影检查的冠心病患者的临床资料，分析不同危险层级患者外周血NT-proBNP水平变化以及其与GRACE评分的相关性。

1 资料与方法

1.1 一般资料

选择2013年1月～2014年4月在深圳市南山区慢性病防治院诊治的冠心病患者231例的临床资料，所有入选患者均先行冠状动脉造影检查，并依其结果分成3组，其中冠状动脉造影正常者57例，男29例，女28例，年龄35～72岁，平均（42.5±5.5）岁，归入对照组；……