施颖超 杨浩 张小英

[摘要] 目的 探討老年冠心病（CHD）患者中血清超敏C-反应蛋白（hs-CRP）及肌钙蛋白I（cTnI）浓度与冠心病疾病类型和冠脉病变严重程度的相关性。方法 选择2016年1月至2018年1月在宁波市医疗中心李惠利医院行CAG检查的疑似冠心病老年患者440例，根据冠脉造影（CAG）结果分为对照组（n=70）和冠心病组（n=370）。冠心病组根据疾病类型分为稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组;根据冠脉狭窄累及的血管数，将其分为单支病变组、双支病变组和三支病变组;根据Gensini评分将其分为冠脉轻度狭窄组、中度狭窄组及重度狭窄组。检测并比较各组患者入院时血清hs-CRP和cTnI浓度。结果 老年冠心病组不稳定型心绞痛的血清hs-CRP浓度显著高于稳定型心绞痛（P<0.05），急性心肌梗死组hs-CRP和cTnI则显著高于不稳定型心绞痛组（P<0.05）;冠心病组中三支病变组血清hs-CRP和cTnI水平显著高于双支、单支病变组（P<0.05），双支病变组高于单支病变组（P<0.05）;冠脉病变Gensini评分越高，血清hs-CRP和cTnI水平明显升高（P<0.05）。 结论 血清hs-CRP和cTnI浓度对不同类型的老年冠心病的诊断及冠脉病变严重程度有一定的预测及诊断价值。

[关键词] 冠心病;超敏C-反应蛋白;肌钙蛋白I;Gensini 评分

[中图分类号] R541.4          [文献标识码] A          [文章编号] 1673-9701（2021）33-0027-04

[Abstract] Objective To investigate the correlation between the concentrations of serum hypersensitive C-reactive protein （hs-CRP） and cardiac troponin I（cTnI） in senile patients with coronary heart disease （CHD） and the type of CHD and severity of coronary artery disease. Methods A total of 440 senile patients with suspected CHD undergoing coronary angiogram（CAG） examination in Lihuili Hospital of Ningbo Medical Center from January 2016 to January 2018 were selected. They were divided into the control group （n=70） and the CHD group （n=370） according to the results of CAG. Meanwhile， the CHD group was divided into the stable angina pectoris group， the unstable angina pectoris group and the acute myocardial infarction group according to disease types. It was divided into the single-vessel lesion group， the double-vessel lesion group and the three-vessel lesion group according to the number of blood vessels involved in coronary stenosis. It was divided into the mild coronary stenosis group， the moderate coronary stenosis group and the severe coronary stenosis group according to the Gensini score. The concentrations of serum hs-CRP and cTnI were detected and compared in each group at admission. Results The concentration of serum hs-CRP in senile patients of the unstable angina pectoris group was significantly higher than those of the stable angina pectoris group （P<0.05）， while that of the acute myocardial infarction group was significantly higher than that of the unstable angina pectoris group（P<0.05）. The concentrations of serum hs-CRP and cTnI in the three-vessel lesion group were significantly higher than those in the double-vessel lesion group and the single-vessel lesion group（P<0.05）， and those in the double-vessel lesion group were higher than those in the single-vessel lesion group（P<0.05）. The higher Gensini score of coronary artery disease， the higher serum hs-CRP and cTnI levels（P<0.05）. Conclusion The concentrations of serum hs-CRP and cTnI have certain predictive and diagnostic value for the diagnosis of different types of CHD and the severity of coronary artery disease.

[Key words] Coronary heart disease; Hypersensitive C-reactive protein; Cardiac troponin I; Gensini score

冠心病是以冠状动脉血管内壁发生动脉粥样硬化为主要病变的一类心血管疾病，冠脉粥样硬化导致血管不同程度狭窄甚至完全阻塞，从而导致心肌缺血、缺氧或坏死。冠心病是中老年人常见的一种心血管疾病，特别是急性心肌梗死是老年患者发病率和致死率较高的疾病之一，严重危害着老年人的身体健康。由于冠心病在老年人中发病隐匿及老年人往往合并较多基础疾病等特点，使得心电图检查在诊断冠心病的敏感性（49%～66%）上大打折扣，因此能够早期识别老年冠心病患者的发病及评估冠脉病变严重程度，从而使老年患者能够得到及时的诊断及治疗已成为一种迫切需求，现报道如下。……