医药学论文：多层螺旋CT冠状动脉成像、超敏C反应蛋白和心肌肌钙蛋白Ⅰ在冠心病不同类型间的应用研究

【摘要】 目的 探讨多层螺旋CT冠状动脉成像（MSCT冠状动脉成像）、超敏C反应蛋白（sCRP）和心肌肌钙蛋白I（cTnI）在冠心病不同类型间的临床应用价值及相互关系。方法 分别对明确诊断为稳定型心绞痛（SA）、不稳定型心绞痛（UA）及急性心肌梗死（AMI）的3组受试患者进行sCRP、cTnI和MSCT冠状动脉成像检查，比较3组sCRP、cTnI水平和MSCT冠状动脉成像结果，并对不同冠状动脉病变支数、狭窄程度以及不同性质斑块间sCRP和cTnI水平进行比较。结果 （1）UA、AMI组sCRP、cTnI均显著高于SA组(P< 0.01)；UA组与AMI组比较，sCRP水平差异无显著性(P>0.05)。（2）3组患者冠状动脉病变支数比较差异无显著性(P>0.05)。而UA、AMI组患者与SA患者在狭窄程度方面比较差异有非常显著性(P< 0.01)。（3）不同病变支数间sCRP及cTnI水平比较，差异无显著性(P>0.05)。（4）不同狭窄程度间sCRP及cTnI水平比较，差异无显著性(P>0.05)。（5）不同性质斑块间sCRP差异有显著性(P< 0.05)。而cTnI水平比较，差异无显著性(P>0.05)。结论 （1）炎症在UA、AMI的发展过程中起重要作用。（2）sCRP可作为判断冠心病严重程度及斑块稳定性的有效指标，其升高与冠心病斑块内炎症有关。（3）UA、AMI患者以轻、中度狭窄为主，SA患者则以重度狭窄为主。（4）cTnI与冠状动脉病变支数、狭窄程度、斑块性质无关。（5）联合检测MSCT冠状动脉成像、sCRP、cTnI，可对不同类型冠心病做出准确的综合评价，特别是对急性冠状动脉综合征的患者可以增加诊断和预后判断的力度。
【关键词】 多层螺旋CT 冠状动脉成像 超敏C反应蛋白 心肌肌钙蛋白Ⅰ 冠心病

【Abstract】 Objective To investigate the correlation and application of multislice spiral computed tomography (MSCT) coronary artery imaging，supersensitive C-reactive protein (sCRP) and troponin I (cTnI) among different types of coronary heart disease (CHD).Methods All subjects，who were examined in MSCT coronary artery imaging，sCRP and cTnI，were divided into stable angina (SA) group，unstable angina (UA) group and acute myocardial infarction (AMI) group.The results of MSCT coronary artery imaging，sCRP and cTnI were analyzed in three groups' patients.sCRP was compared with cTnI in different stenosis，plaques and count of coronary artery.Results (1) sCRP and cTnI of UA and AMI groups were both significantly higher than those of SA group (P< 0.01).UA group compared with AMI group，sCRP was not significantly different (P>0.05).(2) The counts of coronary artery among three groups were not marked differently.However，the patients of UA and AMI groups compared with those of SA group in the degree of coronary artery's stenosis，significant difference was found (P< 0.01).（3）sCRP compared with cTnI in the different count of pathological coronary artery，no difference was found(P>0.05).（4）sCRP compared with cTnI in the different degree of coronary artery's stenosis，no difference is found(P>0.05).（5）Compared with sCRP in different plaques，significant difference was found(P< 0.05).Nevertheless，compared with cTnI，no marked differentce was found(P>0.05).Conclusion （1）Inflammation plays an important role in the developing process of UA and AMI.（2）sCRP might act as an effective index which is used to estimate severe extent of coronary heart disease(CHD) and stability of arteriosclerosis plaque.The raised sCRP was associated with inside inflammation of arteriosclerosis plaque of CHD.（3）Mild and medium stenosis are primary in the patients of UA and AMI.In SA patients，serious stenosis gives priority to.（4）cTnI is not associated with the count of pathologic coronary artery，degree of stenosis and character of plaque.The correct evaluation might be made in different types of CHD by checking sCRP， cTnI and MSCT coronary artery imaging，particularly to the patients with acute coronary syndrome，the exactitude of diagnosis and judgement of prognosis would be improved.