冠心病无心衰患者血浆脑钠素水平检测的临床意义

The Clinical Significance of Detecting Plasma BNP in Coronary Disease Patinets without Heart Failure

目的：观察不同类型冠心病无心衰患者血浆脑钠素（brain natriuretic peptide，BNP）水平的改变并探讨其临床意义。方法：回顾性分析168例冠心病无心衰患者血浆BNP浓度。其中稳定型心绞痛（stable angina，SA组）40例，不稳定型心绞痛（unstable angina，UA组）23例，急性心肌梗死（acute myocardial infartion，AMI组）105例。另外，88例健康体检者为对照组。BNP测定采用ELISA方法。BNP升高的判断标准为血浆BNP浓度≥100pg／ml。结果：SA组血浆BNP浓度中位数42．3（7．6～491．3）pg／ml与正常对照组25．9（5．1～87．9）pg／ml比较差异有统计学意义（P=0．001）。UA组血浆BNP水平142．4（92．4～2617．7）pg／ml，AMI组126．0（5．5～3615．1）pg／ml，均显著高于对照组（均P=0．000）和AS组（均P=0．000）。UA组BNP水平显著高于AMI组（P=0．04）。UA组、AMI组和SA组BNP升高病例百分比分别为95．7％、58．1％和5．0％，差异有显著性（均P=0．000）。结论：急性心肌缺血是血浆BNP水平升高的重要原因之一，血浆BNP水平检测可能有助于急性冠脉综合征与稳定性冠心病的鉴别诊断。

Objective：To observe changes of plasma brain natriuretic peptide （BNP） in different patients of coronary disease without heart failure and also investigate the clinical significance. Method： We retrospectively analyze the plasma BNP concentration in 168 patients of coronary disease without heart failure. Among them, there were 40 patients of stable angina （ SV group） , 23 patients of unstable angina （ UA group）, and also 105 patients of acute myocardial infarction （AMI group）. In addition, 88 healthy examined person were treated as control group. Used enzyme linked immunosorbant assay （ ELISA） to detect the plasma BNP. If the plasma BNP concentration is higher than 100pg/ml,it would be treated as BNP increase. Result： The medium number of plasma BNP concentration in SA group is 42.3 （7.6 -491.3 ） pg/ml, whereas that in control group was 25.9 （5.1 - 87.9 ） pg/ml. The difference between these two groups is statistically significant （ P = 0. 001 ）. The plasma BNP level of UA group 142.4 （ 92.4 - 2617.7 ） pg/ml and AMI group are significantly higher than control group （ P = 0. 000） and AS group （ P = 0.000 ）. And also the plasma BNP level of UA group are significantly higher than that of AMI group （ P = 0.04）. The increase percentage in UA, AMI, and also SA groups are 95.7% .58.1% and 5.0% respectively, differences among which are all significant. Conclusion： Acute myocardial isehemia is one of the important reasons for plasma BNP increase. So the detection of plasma BNP level could be helpful for differential diagnosis between acute coronary syndrom and stable coronary disease.