老年冠心病患者冠状动脉病变程度与血浆B型钠尿肽的关系

目的探讨老年冠状动脉粥样硬化性心脏病（冠心病）患者冠状动脉病变程度与血浆B型钠尿肽（BNP）的关系。方法2010年3月至2011年8月在我院行冠状动脉造影术的老年患者498例。根据造影结果将研究对象分为两组：冠心病组：经冠状动脉造影证实有单支或多支病变，狭窄程度≥50％共406例；对照组：同期住院冠状动脉造影狭窄程度〈50％患者共92例。记录所有研究对象的一般临床指标、左心室射血分数（LVEF）及血BNP等检查结果并进行比较。按冠状动脉病变程度不同，将研究对象分为：单支病变组177例，双支病变组129例，多支病变组100例。又按年龄不同将冠心病患者分为3个亚组：A组254例，年龄60～69岁；B组112例，年龄70—79岁；C组40例，年龄≥80岁。分别比较不同年龄与BNP以及与冠状动脉病变的关系。结果冠心病组患者BNP（387．5±132．3）ng,／L较对照组（58．6±22．1）ng／L明显升高（t=23．83，P〈0．01）；随着冠状动脉病变支数的增加，BNP明显升高，单支病变组为（202．2±116．6）ng／L，双支病变组为（487．5±152．3）ng/L，多支病变组为（768．7±264．3）ng／L，差异有统计学意义（F=87．42，P〈0．01）。随着年龄的增大，BNP亦逐渐升高，A组为（182．6±93．1）ng／L，B组为（352．2±121．2）ng／L，C组为（491．2±158．7）ng/L，差异有统计学意义（17=57．33，P〈0．01）。各组LVEF比较差异无统计学意义（F=0．21，P〉0．05）。结论血浆BNP水平与老年冠心病患者冠状动脉病变程度密切相关，是反映临床心肌缺血重要的预测指标。

Serum brain natriuretic peptide and the severity of coronary artery disease in elderly patients

Objective To investigate the relationship between the level of serum brain natriuretic peptide（BNP） and the severity of coronary artery disease in elderly patients with coronary heart disease（CHD） . Methods We recruited 498 elderly CHD patients undergoing coronary angiography （CAG）from our hospital. Based on CAG results, patients were divided into two groups ： 406 patients with lesion of vessel （s） and ≥50% vessel stenosis as the CHD group, and the other 92 patients with 〈 50% vessel stenosis as the negative control group. Their clinical data such as left ventricular ejection fraction（LVEF） and serum BNP was recorded. The patients was further divided into 177 single-, 129 double-, 100 triple-, and 92 negative vessel disease groups according to the number of vessels with significant stenosis. The patients with CHD were divided into three different age groups： （ 1 ） A group：60 -69 years old,254 patients; （2） B gruup：70 -79 years old, 112 patients ; （3） C group ： equal or greater than 80 years old ,40 patients. Serum levels of BNP were measured before CAG. The relationship between BNP and the severity of coronary disease was analyzed. Results The level of BNP was significantly elevated in the CHD group （387.5 ± 132. 3）ng/L] than the negative control group （58.6 ± 22. 1 ） ng/L] （ t = 23.83, P 〈 0. 01 ）. The level of BNP was significantly enhanced （ F = 87.42, P 〈 0. 01 ） along with the increasing number of coronary artery stenosis, with single vessel disease group （ 202. 2 ± 116. 6）ng/L, double vessel disease group （487.5 ± 152. 3 ）ng/L and triple vessel disease group （768.7 ± 264.3 ） ng/L; the level of BNP significantly increased （ F = 57.33, P 〈 0.01 ） along with increasing age, with A group （ 182. 6 ± 93.1 ） ng/L, B group （ 352. 2 ± 121.2 ） ng/L and C group （ 491.2 ± 158.7 ） ng/L. The level of LVEF did not change in the procedure（P 〉0. 05）. Conclusion The levels of BNP were closely associated with the severity of coronary artery disease and were a strong clinical predictor for myocardial ischemia.