冠心病患者血浆脑钠肽N末端前体浓度的变化及临床意义

目的 分析稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)和非ST段抬高型心肌梗死(NSTEMI)患者以及冠脉介入治疗前后血浆中的脑钠肽(BNP)N末端前体(NT-proBNP)水平的变化,评价血浆NT-proBNP水平与不同冠心病类型的关系,以及心肌缺血改善后血浆NT-proBNP水平的变化.方法 选择住院冠心病患者345例,其中NSTEM组29例,UAP组151例,SAP组165例:同时设正常对照组140例.采用电化学发光双抗体夹心免疫法检测血浆NT-proBNP水平,同时对180例急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后的上述指标进行分析.结果 NSTEMI组NT-proBNP水平明显高于其他三组(P＜0.05),UAP组高于SAP组(P＜0.05),SAP组高于正常对照组(P＜0.05),其中180例ACS患者在经皮冠脉介入术后12～24 h内,血浆NT-proBNP水平UAP组从术前的(1720.53±610.77)ng/L降为(1020.52±510.70)ng/L(P＜0.05),NSTEMI组从术前的(5660.23±1290.53)ng/L降为(2640.20±890.50) ng/L(P＜0.05);术后1周NT-proBNP水平,UAP组降为(359.05±230.33) ng/L;NSTEMI组降为(360.30±210.26)ng/L;与对照组比较均无显著性差异(P＞0.05).血浆NT-proBNP值与心肌TIMI血流评分相关(r=-0.402,P＜0.001).结论 冠心病患者血浆NT-proBNP浓度增高;NT-proBNP水平增高可以预测冠心病的严重程度;ACS患者冠脉介入治疗后血浆NT-proBNP含量明显降低,可作为观察疗效的指标,对临床病情的评估具有重要价值.

The clinical significance of plasma NT-proBNPchanges in patients with coronary heart disease

Objectives To evaluate plasma NT-proBNP levels in patients with stable angina,unstable angina and non-ST elevation myocardial infarction, and to study the relationshiop between the NT-proBNP levels and the severity and extent of coronary vessels involvement. Methods Nonextractable, enzyme-linked, sandwich immunoassay was used to measure the plasma NT-proBNP concentration in patients with acute coronary syndrome induding acute myocardial infarction (n=29), unstable angina pectoris(n=151), stable angina pectoris (SAP)group(n=165), and health controls (n=140). The parameters of heart function were measured by echocardiography. These paremeters were also measured in 180 ACS patients who underwent PCI. Results Plasma NT-proBNP levels in patients with ACS were significantly highter than those in the controls(P<0.001), but the level in SAP group and the controls was not significantly different statistically(P>0.05). But NT-ProBNP levels in the group increased significantly. Conclusions The plasma NT-ProBNP level in coronary artery diseases is increased and it can predict the severity of coronary heart diseases. The plasma NT-ProBNP level decreases markedly in patients who undergo PCI. Therefore it can be used as a a biochemical marker to evaluate the efficacy of PCI.