B型钠尿肽在冠心病严重程度及预后评估中的应用

目的探讨B型钠尿肽（BNP）在冠心病严重程度及预后评估中的应用及作用。方法将胸痛并行冠状动脉造影的患者根据冠状动脉造影结果分为非冠心病组（95例）和冠心病组256例，包括稳定性心绞痛（SA）组（111例）和急性冠状动脉综合征（ACS）组（145例）]。记录受试者的一般情况，记录患者病变支数和Gensini评分。用化学发光法检测基线BNP水平。冠心病患者随访1年，记录主要不良心血管事件。分析不同病例组、不同冠状动脉病变支数患者间及主要不良心血管事件发生患者与未发生患者间的差异。结果冠心病组BNP水平为（137．95±21．58）pg／mL，明显高于非冠心病组（89．05±9．18）pg／mL]（P〈0．01），且患者BNP水平（177．83±22．16）pg／mL]亦高于SA患者（121．17±19．98）pg／mL]（P〈0．01）。冠状动脉三支病变组BNP水平〉二支病变组〉一支病变组（P〈0．05）。按BNP水平把冠心病患者分为三分位低、中、高分位BNP水平分别为112．05±9．52、147．56±17．12、（180．03±22．57）pg/mL]，低分位患者Gensini积分为29．10±4．54，中分位患者为37．76±6．91，高分位患者为58．46±3．71，三者之间差异均有统计学意义（P〈0．05）。随访1年共发生不良心血管事件29例，其中非心源性死亡3例、急诊或择期冠状动脉造影12例、再次经皮冠状动脉介入治疗术（PGI）9例、心源性死亡5例）。不良心血管事件阳性患者BNP水平（205．12±14．73）pg／mL]明显高于阴性患者（108．27±11．96）pg／mL]（P〈0．01）。结论BNP可应用冠心病严重程度及冠心病患者预后评估。

The application of BNP in the evaluation of severity and prognosis of coronary artery disease

Objective To investigate the application and role of B-type natriuretic peptide （BNP） determination in the evaluation of severity and prognosis of coronary artery disease. Methods According to the result of angiograph, 350 patients suffering the chest pain were classified into non-coronary artery disease group （95 patients） and coronary artery disease group（256 patients）stable angina （SA） group （111 patients） and acute coronary syndrome（ACS） group （145 patients） ]. The general information, the number of pathological change branches and the Gensini score of patients were recorded. The level of BNP was detected by chemiluminescence immunoassay. The major adverse cardiac events （MACE） were recorded in 1 year follow-up period. The differences of the level of BNP with the number of pathological change branches and the MACE in different groups were analyzed. Results The coronary artery disease group had the higher level of BNP （ 137.95 ± 21.58） pg/mL] than that of non-coronary artery disease group （89.05 ±9.18） pg/mL, P 〈 0. 01 ]. The level of BNP in the ACS patients （ 177.83±22.16） pg/mL] was dramatically higher than that in SA patients （ 121.17 ±19.98） pg/mL, P 〈0.01]. The level of BNP in the patients with three stenosis branches was higher than that of two stenosis branches, and the level of BNP was higher in two stenosis branches than in single one branch （P 〈 0. 05）. According to the BNP level, the Gensini scores were classified into low group （29.10±4.54）, middle group （37.76 ±6.91） and high goup （58.46 ±3.71 ） with statistical significance （P 〈 0.05 ）, which their BNP levels were 112.05 ± 9.52, 147.56 ± 17. 12 and （180.03 ±22.57）pg/mL in the low, middle and high groups respectively. There were 29 MACE during the follow-up periond including 3 cases with non-carc）iac disease, 12 cases with acute and selective angiograpix, 9 cases administrated the second percutaneous coronary intervention（PCI） and 5 cardiac death cases. The patients suffered from the MACE had higher level of BNP （205. 12 ± 14. 73） pg/mL] than the patients without MACE （108. 27 ±11.96） pg/mL, P 〈0. 01]. Conclusios BNP is one useful marker for the evaluation of severity and prognosis of coronary artery disease.