血浆N-末端脑钠肽前体水平与急性冠状动脉综合征严重程度的关系

Plasm N-terminal pro-B-type natriaretic peptide (NT-proBNP) levels and severity of coronary artery lesions in patients with acute coronary syndrome

目的探讨血浆N末端脑钠肽前体(NT-proBNP)水平与急性冠状动脉综合征(ACS)及冠状动脉病变严重程度的关系。方法对150例胸痛患者行选择性冠状动脉造影,其中ACS78例(ACS组),稳定性心绞痛(SA)33例(SA组),冠状动脉造影正常39例(正常对照组)。采用Gensini积分法评价冠状动脉病变的严重程度,同时测定患者血浆NT-proBNP水平和左室射血分数(LVEF),分析血浆NT-proBNP水平与冠心病临床严重程度及冠状动脉造影Gensini积分之间的关系。结果ACS组患者血浆NT-proBNP水平明显高于SA组和正常对照组(P<0.05)。ACS组患者血浆NT-proBNP水平与冠状动脉造影Gensini积分呈正相关(r=0.8534,P=0.0001),与LVEF呈负相关(r=0.5500,P=0.0001)。结论血浆NT-proBNP水平可反映ACS患者冠状动脉病变的严重程度。

Objective To investigate the relationship between plasm N-terminal pro-B-type natriuretic peptide（NT-proBNP） levels and severity of coronary artery disease and coronary artery lesions. Methods 150 patients complaining of chest pain and suspected to have coronary artery disease （CAD） were enrolled in the study. Plasm NT-proBNP contents were determined with ELISA method within 48h, and left ventricular ejection fraction （LVEF） was assessed with echocardiography 5-7 days after admission. All patients underwent coronary artery angiography（CAG） 2-17 days after admission and the severity of coronary artery lesions was estimated by coronary angiographic Gensini scores. According to the clinical data and results of CAG, 78 patients were diagnosed as acute coronary syndromes （ACS）, 33 patients as stable angina, and 39 patients in whom angiography showed negative findings, served as normal controls. The correlation of plasm NT-proBNP levels with clinical severity of coronary artery disease and Gensini scores were analysed. Results Plasm NT-proBNP levels in patients with ACS, stable angina and in normal controlls were 526. 96±376. 90, 95. 61±56. 32 and 41. 75±24. 26pg/ml,respectively（P〈0. 05）. The Gensini Scores of CAG in patients with ACS, stable angina and in normal controlls were 44. 52±29. 10, 9. 27±2.96 and 0,respectively （P〈0. 01）. Plasm NT-ProBNP levels in patients with left main cronary disease was increased compared with that in patients with 1, 2, or 3 coronary vessels disease Plasm NT-ProBNP levels were positively correlated with the Gensini Scores of CAG in all patients （P=0. 0001） and negatively correlated with LVEF in patients with ACS （P=0. 0001）. Conclusion Plasm NT-proBNP levels is correlated with the clinical severity of CAD and angiogmphic cornary artery lensions in patients with ACS, therefore it can be used as a biochemical marker for risk stratification in patients with CAD.