血浆C-反应蛋白对急性心肌梗死的影响与其预测价值.docVIP

血浆C-反应蛋白对急性心肌梗死的影响及其预测价值 　　作者：温慧华 作者单位： 014010 内蒙古包头，包头医学院第一附属医院心内二科(2004级研究生) 　　【摘要】 目的 探讨血浆C-反应蛋白(CRP)对急性心肌梗死(AMI)发生、发展及预后的影响，以及与心血管其他危险因素的相关性。方法 (1)按WHO诊断标准排除感染、炎症、肿瘤、结缔组织疾病、创伤、痛风、肾脏疾病等，以及利尿剂的使用。选择急性心肌梗死36例，不稳定型心绞痛(UAP)40例，稳定型心绞痛(SAP)40例，正常对照组(Nor)40例。(2)对AMI组病人分别于梗死后4h，6h，12h，18h，24h，30h，48h，1周，2周抽取静脉血3ml，用酶法测定心肌酶，用免疫比浊法测定CRP。而UAP，SAP，Nor组病人分别于入院即刻，第2天清晨空腹抽取静脉血测得心肌酶，CRP值。(3)对所有病人进行空腹血糖、血脂、外周血白细胞的测定和心脏B超检查。对AMI病人的心电图(ECG)进行记分，估测心肌梗死面积。结果 (1)在Nor，SAP，UAP，AMI 4组中，CRP逐渐增高，其中4组CRP比较：除SAP与Nor相比差异无显著性(P0.05)外，其余各组间相比均差异有非常显著性(P0.001)。(2)在AMI组，CRP浓度随时间呈动态变化，约于29.32h达高峰，此后又逐渐下降，而且CRP峰值在溶栓治疗时前移，较非溶栓治疗组提前约9.56h，差异有非常显著性(P0.01)。(3)相关分析：CRP与外周血白细胞、中性粒细胞、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、ECG-ST记分呈正相关，与心搏量，射血分数，左室短轴缩短率呈负相关。结论 CRP随着CHD的发展而增高，可能参与动脉硬化的形成，影响了AMI的发生、发展和预后，且对其发展和预后有判断和预测价值。同时，CRP也是AMI溶栓治疗成功与否的一个有效指标。 　　【关键词】 C-反应蛋白;急性心肌梗死;炎症 　　Effects of C-reactive protein on acute myocardial infarction and its predicted value 　　WEN Hui-hua. 　　The First Affiliated Hospital of Baotou Medical College,Baotou 014010,China 　　【Abstract】 Objective To investigate the relationship between the levels of plasma c-reactive protein(CRP) and acute myocardial infarction(AMI).To observe the relationship between the levels of CRP and the major risk factors of AMI.Methods (1)Serial measurement of serum CRP and creatine kinase (CK) level every 6 hours were performed in 36 patients.(2)The CRP and CK concentration were tested in 40 unstable angina pectoris (UAP)，40 stable angina pectoris(SAP) and 40 normal persons (Nor).(3)To measure the values of blood glucose，blood lipid and white cell count and make a electrocardiogram (ECG) in all patients.(4)To figure out the infarction area of AMI by the score of ECG system.Results (1)The plasma CRP concentration were gradually increasing from Nor group，SAP group，UAP group，and AMI group . There were significant difference in each other but between the CRP level of Nor group and SAP group. There were significant difference in each other.(2)The peak