急性冠状动脉综合征患者血清脑钠肽水平及其与左心室功能的关系

目的 探讨急性冠状动脉综合征(ACS)患者血清脑钠肽(BNP)水平及其与左心室功能的关系.方法 选取2008年1月至2009年1月青岛大学医学院第二附属医院住院的冠心病患者104例,其中ACS 74例[急性心肌梗死(AMI) 36例,不稳定型心绞痛(UAP)38例],稳定型心绞痛(SAP)患者30例,以同期到我院的体检健康者30名作为正常对照组.用酶联免疫吸附测定法分析血清BNP浓度,并行心脏超声心动图检查.测定所有研究对象的左心室射血分数(LVEF)、左心室收缩末期容积及舒张末期容积.结果 ACS组(AMI组和UAP组)的血清BNP浓度[(391±136) ng/L,(267±80) ng/L]均明显高于SAP组[(36±21)ng/L]和对照组[(33±14)ng/L],差异均有统计学意义(均P＜0.05),在LVEF正常的冠心病患者,ACS组的BNP水平[(277±160) ng/L]高于SAP组[(74±32) ng/L],差异有统计学意义(P＜0.05),ACS组BNP与LVEF呈负相关(r=-0.44,P＜0.01).结论 ①血清BNP浓度在ACS患者中升高.②ACS患者BNP浓度的升高除了与心脏大小和射血分数相关外,也可能与缺血损伤造成的急性期炎症反应有关.

Study of brain natriuretic peptide and left ventricular function in acute coronary syndrome

Objective To detect the expression of serum brain natriuretic peptide （BNP） and relation with the function of left ventricular in the patients with acute coronary syndrome. Methods Patients with acute myocar- dial infarction （AMI） （36 cases）, unstable angina pectoris （UAP） （38 cases ）, stable angina pectoris （SAP） （30 ca- ses） were selected, 30 cases with normal physical examination were chosen as control group. The serum BNP con- centration determined with enzyme linked immuno-asorbent assay method echocardiography was performed in all pa- tients. The left ventricular ejection fraction, the end of the left ventricular systolic and end-diastolic volume were de- termined. Results The BNP serum concentration of AMI group （391 ＋ 136）ng/L and UAP group （267 ＋ 80） ng/ L were significantly higher than SAP group （36 ＋ 21 ）ng/L and control group （33 ＋ 14）ng/L, the difference was significant （P 〈 0.05）. Normal LVEF of patients with coronary heart disease, the serum BNP concentration in ACS group（277 ＋ 160）ng/L was higher than SAP group （74 ＋ 33 ）ng/L. The serum BNP concentration in ACS group was negative correlated with LVEF（r = - 0.44, P 〈 0.01 ）. Conclusions The serum BNP concentration in patients with ACS increase significantly. BNP concentration increases in patients with ACS, which is mainly caused by vol- ume of heart the size and ejection fraction, while acute phase of the inflammatory response after ischemic contributes to increase.