目的 探讨血清渗透压（SOSM）联合N-端脑利钠肽前体（NT-proBNP）、同型半胱氨酸（Hcy）检测在冠心病合并高血压患者发生急性心力衰竭（AHF）时的应用价值。 方法 回顾性选取2023年1月至2024年12月就诊于合肥市第二人民医院的130例冠心病合并高血压患者为研究对象，根据临床诊断可分为AHF组58例、非AHF组72例，选取同期64例单纯高血压患者为对照组，检测3组患者血清NT-proBNP、Hcy、低密度脂蛋白胆固醇（LDL-C）；用血清钠（Na）、钾（K）、葡萄糖（GLU）、尿素（UREA）水平来计算SOSM，比较3组SOSM、NT-proBNP、LDL-C和Hcy间有无统计学差异。对患有冠心病合并高血压的130例观察对象，二元logistic回归分析得出冠心病合并高血压患者发生AHF的良好诊断指标；受试者工作特征（ROC）曲线分析各指标水平在冠心病合并高血压患者发生AHF时的应用价值。 结果 SOSM、Hcy、NT-proBNP、LDL-C水平3组间比较，差异均有统计学意义（P < 0.05）；AHF组中NT-proBNP、SOSM、Hcy水平均高于非AHF组和对照组（P < 0.05）；AHF组和非AHF组ROC曲线显示，联合检测的ROC曲线下面积（AUC）为0.927，高于各单项指标，灵敏度升高，特异度高。 结论 血清NT-proBNP、SOSM和Hcy联合检测在冠心病合并高血压患者发生AHF的早期诊断、病情评估上发挥重要作用。

Objective To explore the application value of detecting serum osmotic pressure （SOSM） in combination with serum N-terminal pro-brain natriuretic peptide （NT-proBNP） and homocysteine （Hcy） in patients with coronary heart disease and hypertension who suffer from acute heart failure. Methods A retrospective study was carried out on 130 patients with coronary heart disease and hypertension who visited the Second People's Hospital of Hefei from January 2023 to December 2024. Based on clinical diagnosis， they were divided into an acute heart failure （AHF） group consisting of 58 cases and a non-acute heart failure group with 72 cases. A control group of 64 patients with simple hypertension was selected during the same period. Serum NT-proBNP， Hcy， and LDL-C were measured in the three groups of patients. SOSM was calculated using serum sodium （Na）， potassium （K）， glucose （GLU）， and urea （UREA） levels， and then a comparison was made to determine whether there were statistical differences in SOSM， NT-proBNP， LDL-C， and Hcy among the three groups. A binary logistic regression analysis was performed on the 130 observation subjects with coronary heart disease complicated by hypertension， and a good diagnostic indicator for acute heart failure in patients with coronary heart disease complicated by hypertension was obtained. The application value of Receiver Operating Characteristic （ROC） curve analysis of various indicator levels in acute heart failure in patients with coronary heart disease and hypertension was also explored. Results The differences in SOSM， Hcy， NT-proBNP， and LDL-C levels among the three groups were statistically significant （P < 0.05）. The levels of NT-proBNP， SOSM， and Hcy in the AHF group were higher than those in the non-AHF group and the control group （P < 0.05）. The ROC curves of the AHF group and the non-AHF group showed that the area under the ROC curve of the combined detection was 0.927， which was higher than that of each individual indicator. The sensitivity increased， and the specificity was high. Conclusion The combined detection of serum NT-proBNP， SOSM， and Hcy plays a crucial role in the early diagnosis and assessment of acute heart failure in patients with coronary heart disease and hypertension.