血浆C型钠尿肽在急性冠脉综合征患者的变化及其意义

Plasma level of C-type natriuretic peptide in patients with acute coronary syndrome and its clinical significance

目的观察急性冠脉综合征(ACS)患者不同情况下血浆C型钠尿肽(CNP)水平,探讨CNP在ACS发病过程中的意义。方法用放射免疫分析法检测35例ACS患者经皮冠脉介入治疗(PC I)术前、术后24 h血浆CNP水平,并与20例正常对照组血浆CNP进行对比。观察并分析ACS患者PC I前血浆CNP水平与心功能及冠脉狭窄积分间的关系。结果ACS患者入院时血浆CNP水平高于正常对照组[(6.8±1.4)pg.m l-1vs(5.1±1.6)pg.m l-1,P<0.01],且PC I后24 h血浆CNP的水平较术前明显增高[(10.9±2.9)pg.m l-1vs(6.8±1.4)pg.m l-1,P<0.001]。PC I前左室射血分数(LVEF)<50%的患者血浆CNP水平明显高于LVEF>50%的患者[(7.8±1.1)pg.m l-1vs(6.1±1.2)pg.m l-1,P<0.001],但是血浆CNP水平与心功能分级(NYHA)未见相关性。冠脉Gensin i积分与PC I前血浆CNP水平呈高度正相关(r=0.76,P<0.001)。结论ACS患者血浆CNP水平明显增高,介入治疗后ACS患者血浆CNP水平继续增高,CNP在ACS发病中的意义值得进一步研究。

Objective To explore the significance of plasma C-type natriuretic peptide（CNP） level in patients with acute coronary syndrome（ACS）. Methods Thirty-five patients with ACS and twenty healthy subjects as control were selected into this protocol. Blood samples of ACS patients were extracted on admission immedi- ately and at 24 h after percutaneous coronary intervention （PCI）. The plasma CNP was measured by radioimmunoassay. The plasma levels of CNP were compared among those of before and after PCI, ACS patients and healthy controls, and different conditions of heart function. The relationship between the plasma levels of CNP with Gensini scores was studied by correlation analysis. Results The plasma level of CNP was significantly increased in patients with ACS compared with that of the control subjects [ （6. 8 ±1.4） pg· ml^-1 vs （5.1 ±1.6） pg· ml^-1, P 〈0.01], and CNP was increased after PCI [（10.9±2.9） pg· ml^-1 vs （6.8±1.4） pg·ml^-1, P 〈 0. 001 ]. The plasma CNP level in patients with LVEF 〉 50% before PCI was higher than that in patients withLVEF〈50% [（7.8±1.1） pg·ml^-1vs （6.1±1.2） pg· ml^-1, P〈0.001], but there was no significant relationship among different NYHA with CNP levels （ P 〉 0.05 ）. Coronary Gensini scores were correlated with the plasma levels of CNP in ACS group （r = 0. 76, P 〈 0. 001 ）. Conclusions Plasma level of CNP is increased significantly in ACS patients, and increased further after PCI. The pathological role of CNP during process of ACS remains to be investigated.