经皮球囊二尖瓣成形术后房颤患者ANP和BNP水平变化研究

目的探讨房颤患者行经皮球囊二尖瓣成形术（PBMV）后心房利钠肽（ANP）和脑钠肽（BNP）变化及与血流动力学参数的关系。方法选择因风湿性二尖瓣狭窄伴持续性房颤成功行PBMV患者38例,术前、术后1d及半年分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径（LAD）、二尖瓣口面积（MVA）、二尖瓣跨瓣压差（MPG）及肺动脉压（PAP）。结果PBMV术后患者血流动力学参数明显改善;术后1d及半年ANP水平较术前明显下降,BNP变化不明显。术后半年与术前比较,LAD与ANP下降相关（r=0．774,P〈0．05）,△BNP与△MPG相关（r=0．574,P〈0．05）。结论房颤患者PBMV术后半年血中ANP逐步下降,BNP降低不明显。房颤律时△ANP和△BNP仍是反映LAD和MPG变化的有效指标。

Changes of ANP and BNP in plasma after percutaneous balloon mitral valvuloplasty in patients with atrial fibrillation

Objective To observe the changes of atrial natriuretic peptide （ANP） and brain natriuretic peptide （BNP） in plasma and the correlation of ANP and BNP with hemodynamic parameters in patients with atrial fibrillation after pereutaneous balloon mitral valvuloplasty （PBMV）. Methods 38 patients with rheumatic mitral stenosis and atrial fibrillation undergoing first time successful PBMV were selected to this study. The levels of ANP and BNP were assayed before and 1-day and 6-month after PBMV. Hemodynamic parameters including left atrial dimension （LAD）, mitral valve area （MVA）, mitral pressure gradient （MPG） and pulmonary artery pressure （PAP） were all measured by echocardiography. Results After PBMV, hemodynamic parameters improved significandy. The ANP levels gradually decreased at 1-day and 6-month after procedure （P 〈0.05）. However, BNP levels increased at first and then decreased （P 〉0.05）. The changes of plasma ANP （AANP） were correlated with the changes of LAD （ r = 0. 774 ; P 〈 0.05 ） , and the relationship between ABNP and mitral pressure gradient （AMPG） was correlation （ r = 0.574 ; P 〈 0.05 ）. Conclusions 6 months after PBMV, the levels of ANP decreased gradually, but the changes of BNP were not significant than before PBMV. AANP and ABNP are still valid markers reflecting changes of LAD and MPG in patients with atrial fibrillation.