【摘要】 目的:探讨血清超敏C反应蛋白(Hs-CRP)及胱抑素C(CysC)水平检测在急性心肌梗死(AMI)后心室重构程度中的临床意义。方法:选择AMI患者160例为观察组,另选同期体检者80例为对照组。测定观察组发病后24h以内和对照组血清Hs-CRP及CysC的浓度水平。并根据Hs-CRP及CysC的浓度水平将观察者分为四个小组:A组为血清Hs-CRP及CysC水平均升高,B组为Hs-CRP升高CysC正常,C组为Hs-CRP正常CysC升高,D组为Hs-CRP及CysC均正常。随访6个月。应用超声心动图测定观察组发病后96h内和随访末(6个月)以及对照组左心室舒张末期容积、左心室射血分数、左室收缩末期容积指标,并以随访末(6个月)左心室舒张末期容积增长率△LVEDV%≥20%定义为心室重构。比较五组间心脏超声的指标及心室重构的发生率,分析AMI后心室重构程度与血清Hs-CRP和CysC水平的相关性。结果:与对照组相比,观察组血清Hs-CRP、CysC水平均显著增加,LVEDV、LVESV显著增大,LVEF显著降低,(P均<0.05);A组与B、C、D组相比较:LVEDV、LVESV增大,LVEF降低,心室重构发生率升高,(P均<0.05);B组及C组与D组相比较:LVEDV、LVESV较D组增大,LVEF降低,心室重构发生率升高,(P均<0.05);多因素Logistic回归分析显示,血清Hs-CRP及CysC水平升高是AMI后心室重构程度的独立预测因素之一(P<0.05)。结论:血清Hs-CRP及CysC水平与AMI后心室重构密切相关,是预测AMI后心室重构程度的可靠指标。更多还原

【Abstract】 Objective: To investigate the correlation between the levels of serum hypersensitive C-reactive protein(Hs-CRP) and cystatin C(CysC) and the degree of ventricular remodeling after acute myocardial infarction(AMI). Methods: 160 patients with AMI were selected as the observation group, and 80 patients with physical examination at the same time were selected as the control group. The serum levels of Hs-CRP and CysC were measured within 24 hours after the onset of the disease in the observation group and in the control group. According to the concentration levels of Hs-CRP and CysC, the observers were divided into four groups: group A had elevated serum Hs-CRP and CysC levels, group B had elevated serum Hs-CRP levels and CysC levels were normal, group C had elevated normal CysC levels of Hs-CRP, and group D had normal Hs-CRP and CysC levels. The follow-up period was 6 months. The left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF) were measured by echocardiography within 96 hours after onset and at the end of follow-up(6 months) as well as in the control group. The left ventricular remodeling was defined as the growth rate of left ventricular end-diastolic volume(LVEDV%>20%) at the end of follow-up(6 months). The indexes of echocardiography and the incidence of ventricular remodeling were compared among the five groups. The correlation between the degree of ventricular remodeling and the levels of hs CRP and CysC in serum was analyzed. Results: The serum levels of Hs-CRP and CysC in the observation group were significantly higher than those in the control group, LVEDV and LVESV were higher and LVEF was lower than those in the control group(all P<0.05). Compared with group B, C and D, the levels of LVEDV and LVESV were higher, the incidence of ventricular remodeling was lower and the incidence of ventricular remodeling was higher in group A(all P<0.05). Compared with group D, the levels of LVEDV and LVESV in group B and C were higher, the LVEF was lower and the ventricular remodeling was lower. Incidence rate increased(P<0.05). Multivariate logistic regression analysis showed that elevated serum levels of Hs-CRP and CysC were independent predictors of ventricular remodeling after AMI(P<0.05). Conclusion: Serum levels of Hs-CRP and CysC are closely related to ventricular remodeling after AMI, and they are reliable indicators for predicting the degree of ventricular remodeling after AMI.更多还原