经皮二尖瓣球囊扩张术后血浆B型钠尿肽水平的变化

Changes of plasma B-type natriuretic peptide after percutanouse balloon mitral valvuloplasty

目的:观察心房压力快速变化对血浆B型钠尿肽(BNP)水平的影响。方法:采用床边快速BNP试验法检测30例成功施行二尖瓣球囊扩张术(PBMV)的风湿性二尖瓣狭窄患者术前、术后20min及术后24h血浆BNP浓度,与正常对照组(8例)比较,并将患者血浆BNP浓度与平均左房压(mLAP)等血流动力学参数作相关分析。结果:术前,二尖瓣狭窄患者血浆BNP水平显著高于正常对照组[(123.55±69.49)ng/L∶(16·39±7·64)ng/L,P<0·01)];且与mLAP呈显著正相关(r=0·441,P<0·05);BNP浓度在心房颤动(房颤)患者与窦性心律患者间差异无统计学意义(P>0·05)。术后,房颤患者血浆BNP浓度无明显改变[术前(111.62±53.41)ng/L,术后20min(122.04±68.70)ng/L,术后24h(106.11±56.19)ng/L,两两比较P>0·05];而窦律患者有显著下降[术前(128.66±75.96)ng/L,术后20min(88.59±61.99)ng/L,术后24h(43.39±26.70)ng/L,两两比较P<0·05)]。窦律患者中,术后20min的BNP变化(ΔBNP)与mLAP变化(ΔmLAP)呈显著正相关(r=0·696,P<0·01);术后24h的BNP变化(ΔBNP')与二尖瓣口面积(MVA)的扩大值(ΔMVA)及左房内径(LAD)的变化(ΔLAD)无相关性(分别r=0·048,P>0·05;r=-0·070,P>0·05)。结论:二尖瓣狭窄患者血浆BNP水平的升高和左房压升高显著相关。BNP是反映窦律患者球囊扩张术后左房压变化的敏感指标。

Objective： To assess the effect of acute changes in left atrial pressure on plasma B-type natriuretic peptide （BNP） levels. Method.Thirty patients of rheumatic mitral stenosis treated by percutaneouse balloon mitral valvuloplasty （PBMV） were included in this study. Plasma BNP concentrations were measured by the Triage BNP Test in all patients before, at 20 minutes and 24 hours after PBMV, and in eight healthy volunteers. The relations between BNP concentrations and mean left atrial pressure （mLAP） and other hemodynamic parameters were stud ied. Result：Plasma BNP levels in patients were significantly higher than those in the control group （[123.55±69.49]ng/L ： [16.39±7.64]ng/L, P %0. 01）, and basal plasma BNP level was significantly correlated with basal mean left atrial pressure （mLAP） （ r =0. 441, P 〈0. 05）. But there was no difference in BNP concentrations between patients with sinus rhythm （SR） and patients with atrial fibrillation （AF） （ P 〉0.05）. Plasma BNP levels remained unchanged in patients with AF after PBMV （before, [111. 62±53.41]ng/L; at 20 minutes, [122.04±68.70]ng/L; at 24 hours, [106.11±56.19]ng/L; respectively, P ;〉0.05）, whereas it decreased significantly inpatients with SR after the procedure（before,[128.66 ± 75.96]ng/L;at 20 minutes, [88.58±61. 99]ng/L; at 24 hours, [43. 39±26.70]ng/L; respectively, P 〈0.05）. In SR patients, there was a positive correlation between changes in plasma BNP at 20 minutes （ABNP） and changes in mean left atrial pressure （AmLAP） （ r 0. 696, P〈0.01）. No relationships were observed between changes in BNP level at 24 hours （ABNP＇） and those in left atrial diameter （ALAD） or in mitral valve area （AMVA） （ r =0. 048, P 〉0.05; r =-0. 070, P 〉0.05, respectively）. Conclusion：These results indicate that high BNP level is associated with high left atrial pressure in mitral stenosis patients. BNP may be a valid marker to reflect changes in mLAP after PBMV in sinus rhythm patients.