| BackgroundCoronary atherosclerotic heart disease referred to as coronary heart disease,coronary heart disease is the result of myocardial ischemia, hypoxia caused by coronaryatherosclerotic, which leading to the most common type of organ. The incidence ofcoronary heart disease increases every year, how fast and effective identification ofpatients with chest pain, especially for the early diagnosis of acute myocardial infarctionand intervention, is still the challenge of clinical work.In recent years, as a predictor of coronary heart disease, useful biomarkers toolshave been paid to more attentions gradually. And peptide hormone (copeptin) is thearginine vasopressin of the original (pre-provasopressin) of the C-terminal part ofarginine vasopressin (AVP), also known as vasopressin, the hypothalamic supraopticnucleus and Para ventricular nuclear cells, stored in the neurohypophysis. Studies havefound increased levels of AVP was significantly associated with cardiovascular disease,but the plasma half-life of AVP in a short time, measured in vitro is very difficult. Thecopeptin and AVP as part of the active fragment of the same trend, and are easy to save,easy detection and so on. Research shows, copeptin levels in patients with acutemyocardial infarction and heart failure was significantly increased. copeptin is acoronary heart disease, heart failure, new detection marker.Recently studies have found that myocardial ischemia is an important stimulusfactor for NT-proBNP release, ACS NT-proBNP plasma levels increase and relate withthe severity of coronary lesions and myocardial necrosis area, NT-proBNP levels reflectto the extent and severity of ischemic injury. Detect patients with ACS NT-proBNPplasma levels have a lot of advantages in clinical prognosis, diagnosis and treatment.ObjectiveTo investigate the changes of copeptin, N-terminal brain natriuretic peptide(NT-proBNP) levels in patients with coronary heart disease (CHD) of the clinicalsignificance. Subjects and methodsTotal of121study objective selected from June2010to June2011，whichbecause of chest pain and hospital stay in department of cardiovascular. according to theresults of coronary angiography(CAG), patients were divided into control group(coronary stenosis＜50%) of32patients,17men patients,15females, aged34-77(57.8±10.7) years; CHD group (defined as at least one major vascular stenosis≧50%)89cases, according to the relevant clinical data CHD patients will be divided into SAPgroup,22cases12were males and10females, aged48-78(65.3±9.1) years; UAPgroup of34patients,19males and15females, aged46-85(66.3±9) years of age; AMIgroup33patients,16men patients,17females, aged34-77(61.1±11) years of age.The CHD patients were further divided into subgroups according to the number ofdiseased coronary branches and Gensini’s score, according to the number of diseasedcoronary cases were divided into subgroups as left main disease, single vessel diseases,double vessel diseases and three-vessel disease. According to Gensini’s score caseswere divided into subgroup as0＜points＜20,20≦points＜40and points≧40. Plasmalipids, fasting plasma glucose, blood pressure, body mass index were measured, and age,sex and prior medical histories including hypertension, diabetes mellitus and smokingstatus were obtained before CAG in all patients. Copeptin and NT-proBNP levels werecompared statistically between the subgroups, and correlation coefficient of copeptin,NT-proBNP and other conventional risk factors for CHD was calculated. These caseswere excluded due to various reasons, pulmonary hypertension, pulmonary heartdisease, LVEF＜45%, a history of coronary artery reconstruction, severe liver andkidney dysfunction, blood diseases, cancer, severe infection and previous myocardialinfarction or heart function insufficiency in patients with a history of impactmeasurement indicators.Data processing and statistical analysisEpidata3.0software was adopted to build the data entry system. Formal data wereentered twice by different people and were double checked one by one. After that，SPSS17.0software was used to process the data, Normal distribution of data in eachgroup tested, which meet normally distributed were expressed as mean value±standarddeviation(SD). the comparison between two groups was made using2independent-samples t test, and One-Way ANOVA or Kruskal-Wallis H test wasadopted to do significance tests in multi-groups (significance level P<0.05). thechi-square test Was adopted to do significance tests in Categorical variables (significance levelP<0.05), Correlation using Pearson correlation analysis.Result①Plasma copeptin, NT-proBNP levels in CHD patients were significantly higher than controlgroup (t=5.033, t=7.504, P＜0.01). And AMI patient’s copeptin, NT-proBNP levels above theUAP group (t=3.155, t=4.542, P＜0.01). UAP patient’s copeptin, NT-proBNP levels higher thanthe SAP group (t=3.252, t=5.141, P＜0.01).②plasmaNT-proBNP levels in Left main diseasegroup were significantly higher other subgroups (P＜0.01); plasma copeptin levels in Left main disease were significantly higher than control and single vessel diseases group (P <0.05),butplasma copeptin in double vessel diseased subgroup and three vessel diseased subgroup have nosignificant statistical difference (P=0.419,0.569).③Plasma copeptin, NT-proBNP levels inGensini’s score＞20subgroup (include20＜Gensini’s score＜40subgroup and Gemini’s score≧40subgroup) was respective significantly higher than that in controls and0＜Gensini’s score＜20subgroup(P＜0.05).④plasma copeptin, NT-proBNP levels and Gensini score of coronaryangiography showed a positive correlation (r=0.638， r=0.721，P＜0.001); plasma copeptin,NT-proBNP levels were negatively correlated with LVEF (r=-0.435， r=-0.479，P＜0.001).⑤Plasma copeptin, NT-proBNP levels were having a positive correlated with fasting plasmaglucose(FPG), body mass index, but were showed no correlated with age,blood pressure,,hypertension, diabetes mellitus, TC, TG, LDL.ConclusionPlasma copeptin, NT-proBNP levels were particularly significantly higher in the double vesseldisease, three vessel disease,20≤Gemini’s score＜40and Gemini’s score＞40group, which suggestthat combination detect of copeptin and NT-proBNP levels has some clinical significance indiagnosis, disease assessment, risk stratification in patients with chest pain. |
PDF Full Text Request