HCY、CRP、Fib、WBC 水平在冠心病诊断中的临床价值

目的:探讨血清同型半胱氨酸(HCY)、C反应蛋白、纤维蛋白原(Fib)、白细胞(WBC)与冠心病(CHD)病变程度的相关性和作为检测指标的敏感性;检测BMI是否为CHD的独立风险因子。方法:测定102例不同类型冠心病患者和33例健康的HCY、CRP、Fib、WBC的水平,比较AMI.UAP.SAP组和对照组间各项指标的差异。结果:BMI24和BMI24两组中AMI、UAP、SPA和Control的构成比的差别,结果显示男性患者中两组构成有明显差异(P=0.011);女性患者中两组构成没有明显差异(P=0.28)。各组的HCY、CRP、Fib和WBC的水平为:AMI组大于UAP组大于SAP组大于对照组,AMI组与UAP组相比,差异有统计学意义(均为P0.01),UAP组与SAP组相比,差异有统计学意义(P0.05,P0.01)。CRP和WBC的诊断价值较好,HCY和Fib的诊断价值中等。结论:同型半胱氨酸、C反应蛋白、纤维蛋白原和白细胞水平变化与冠心病的发生、发展密切相关,它们的四个指标可作为区别冠心病类型和评价其病变严重程度的辅助性指标。

The Clinical Value of Homocysteine, C-reactive Protein, Fibrinogen and White Blood Cell Count in Diagnosis of Coronary Disease

Objective:To research the correlation of homocysteine (HCY), C-reactive protein(CRP), fibrinogen (FIB) and white blood cell count (WBC) with pathological change degree of coronary heart disease (CHD) and the sensitivity as indictors of CHD, and to investigate whether BMI is the independent risk factor of CHD.Methods:The levels of HCY, CRP, Fib and WBC were measured and compared in 102 cases of CHD and 33 cases of healthy controls (healthy control group).Results:BMI risk prediction values in male patients (OR) was3 (P=0.0453), and the results showed BMI> 24 was an independent risk factor for the male to have MI. The BMI risk prediction (OR) was 0.61 for female patients (P=0.4274), and the results showed a BMI> 24 was not a risk factor for the female to have MI disease. It is showed that male patients between BMI> 24 group and BMI <24 group had differences (P=0.011) in constituent ratio of AMI, UAP, SPA and Control, while female patients in the two groups had no significant difference (P=0.28). Plasma concentrations of HCY, CRP, Fib and WBC were the highest in AMI group, followed by those in UAP group, SAP group and healthy control group. There were statistical differences in the above parameters between AMI group and UAP group (all P<0.01), and so were between UAP group and SAP group (P<0.05, P<0.01). There was no significant difference between UAP group and healthy control group (P>0.05). ROC curve of HCY was 0.84, ROC curve of CRP was 1, ROC curve of Fib was 0.75, ROC curve of WBC was 0.96. The results showed that the diagnostic value of CRP and WBC was better than diagnostic value of HCY and Fib.Conclusion:The changes of HCY, CRP, Fib and WBC were closely associated with the occurrence and development of coronary heart disease. The above four parameters can be used as adjuvant indicators in differentiating types of CHD and evaluating severity of disease.