冠脉病变程度与脑钠肽的相关性研究

Relationship between the extent of coronary artery lesions and plasma brain natriuretic peptide

目的研究非心衰冠心病患者冠脉病变程度与血浆脑钠肽（BNP）水平的相关关系及其临床意义。方法选取浙江大学医学院附属第一医院心内科2007年3至5月住院的非心衰冠心病患者70例，符合冠心病临床诊断且冠脉造影结果阳性，将其分为三个组：稳定型心绞痛组24例，不稳定型心绞痛组25例，心肌梗死组21例。同时选取无冠心病病史且冠脉造影阴性者20例作为对照组。冠脉造影前用ELASA法测定各组血浆BNP浓度，冠脉造影后计算各组冠状动脉病变的支数和评分。比较冠心病各组与对照组的BNP水平，并将冠状动脉病变支数、评分与BNP水平作相关性分析。所得数据用SPSS13．0统计软件处理，计量资料用均数±标准差（-↑x±s）表示，显著性检验使用两个独立样本的非参数检验，以P〈0．01为差异具有统计学意义，相关分析选择spearman相关系数。结果冠心病各组BNP水平均高于对照组，尤以心肌梗死组明显，与对照组之间比较差异具有统计学意义（P〈0．01）。血浆BNP水平与冠状动脉病变支数、评分之间呈正相关关系，相关系数分别为r1=0．309、r2=0．279（P=0．01）。结论在排除心衰因素后，冠心病患者冠状动脉病变程度越重，BNP水平越高。冠状动脉病变所致的心肌缺血的严重程度与BNP水平相关，测定血浆BNP水平可对冠心病患者冠状动脉病变程度提供有价值的参考依据。

Objective To explore the relationship between the extent of coronary artery lesions and plasma brain natriuretic pepfide（BNP） levels in the patients with coronary artery disease（CAD） except for congestive heart failure（CHF）. Method Seventy CAD patients without CHF evidenced by dinical manifestation and coronary arteriography （CAG） from Cardiology Department of the First Affiliated Hospital of Zhejiang University School of Medicine, China, were enrolled in the study. These patients were diagnozed under coronary arteriography （CAG） during March to May of 2007. They were divided into 3 groups： stable angina group （24 patients）, unstable angina group （25 patients）,myocardial infarction group （21 patients）. Twenty patients without coronary history and with normal CAG served as controls. Plasma BNP concentrations were measured with ELASA before CAG. The coronary lesion vessels and scores were estimated after CAG. The relationship between BNP levels and the coronary lesion vessels, as well as scores in CAD was analyzed. The data were expressed as （-↑ x ± s ） and was analyzed by using 2 independent samples test and spearman correlation with SPSS 13.0. A P value less than 0.01 indicated statistical significance. Results The plasma BNP concentrations in the patients, especially in the patients with myocardial infarction, were significantly higher than those in the controls. Spearman analysis showed that there was a positive correlation between the BNP levels and coronary lesion vessels （ r1 = 0. 309, P = 0. 01 ）, also between BNP and coronary lesion score （ r2 = 0. 279, P = 0. 01 ）. Conclusions In the patients without congestive heart failure, the more serious the coronary artery lesions, the higher the plasma BNP concentrations were. The degree of myocardial ischemia caused by coronary artery lesions was correlated with the plasma BNP level. Plasma BNP concentration could be valuable for the extent of coronary artery lesions in the patients of coronary artery disease.