脑钠肽对2型糖尿病患者心血管危险预测作用的临床研究

目的 探讨脑钠肽(BNP)与2型糖尿病患者的心血管危险因素的关系、BNP水平与糖尿病患者合并冠心痛的严重程度及其近期预后的关系,探寻一种评价2型糖尿病患者心血管危险的方法.方法 以154例2型糖尿病患者作为研究对象,其中合并原发性高血压65例,合并冠心痛95例.合并冠心病者按临床类型分为稳定型心绞痛组30例、不稳定型心绞痛组33例、急性心肌梗死组32例.观察入选患者的BNP水平和各种心血管危险因素的关系;对合并冠心痛者,观察BNP水平和冠心病不同类型之间的关系,随访6个月观察BNP对合并冠心痛患者死亡的预测作用.结果 入选患者的BNP平均为(397.34±217.79)ng/L,2型糖尿病患者的BNP水平与患者的年龄、CRP、高血压及冠心病正相关(Spearman等级相关指数分别为0.631、0.672、0.762、0.857,P均<0.05);2型糖尿病患者BNP水平随患者年龄升高而升高(r=0.896,P<0.01):<50岁组(57.6±12.3)ng/L,50～59岁组(146.2±53.4)ng/L,60～69岁组(388.4±67.5)ng/L,≥70岁组(423.8±132.6)ng/L(P<0.01或P<0.05);2型糖尿病患者合并原发性高血压者较无高血压合并症者BNP明显升高(314.7±125.3)ne/L与(136.8±98.7)ng/L,P<0.01];合并冠心病的患者BNP高于无冠心病合并症的患者(425.03±200.80)ng/L与(37.64±21.57)ng/L,P<0.01],合并冠心痛BNP水平与近期预后关系密切,BNP浓度≥485 ng/L为1个月内心源性死亡的独立预测因素.结论 糖尿病患者的BNP水平和患者的心血管危险相关,对合并冠心病者BNP可作为预测心血管危险的指标.

Clinical study of the predicting values of brain natriuretic peptide on cardiovascular risks in patients with type 2 diabetes

Objective To explore the relationship of plasma level of B-type natriuretic peptide (BNP) with cardiovascular risk,the severity of coronary heart disease(CHD),and the short-term prognosis in patients with type 2 diabetes. Methods 154 patients with type 2 diabetes,of them 95 cases complicated with CHD and 65 with hyper-tension were selected in this study. The CHD patients were diveded into 3 groups: AMI(n=32), UAP(n=33) and SAP(n=30). The relationship of the plasma BNP levels with cardiovascular risks, with each coronary heart disea-ses,were observed. The patients were followed up for 6 months to study the predicting role of BNP on the death in pa-tients accompanied with CHD. Results The plasma BNP level was (397.34±217.79) ng/L, which was correlated with age, CRP, hypertension and CHD (r=0.631,0.672, 0.762,0.857, P<0.05 for each);the plasma BNP levels increased with age(r=0.896,P<0.01):(57.6±12.3) ng/L in patients <50 years old,(146.2±53.4)ng/L in patients 50≤and < 59 years old, (388.4±67.5) ng/in patients 60≤and < 69 years old, and (423.8±132.6) ng/L in patients≥70 years old (P<0.01 or P<0.05). The plasma BNP levels, was higher in patients with hyper-tension than that in patients without hypertension (314.7±125.3) ng/L vs (136.8±98.7) ng/L, P<0.01];Higher in patients with CHD than that in patients without CHD (425.03±200.80)ng/L vs (37.64±21.57) ng/L,P<0.01)]. The short-term prognosis of patients with CHD was correlated with the levels of BNP, and BNP levels≥485 ng/L may be an independent predicting factor for cardiac death within one month. Conclusions Plas-ma levels of BNP were associated with some cardiovascular risks,which may be one of biomarkers for cardiovascular risks in patient complicated with CHD.