急性冠脉综合征血清脑钠肽水平的变化及阿托伐他汀的干预作用

Changes of B-type natriuretic peptide content in patients with acute coronary syndrome and effect of atorvastatin

目的:探讨血清脑钠肽(BNP)浓度在急性冠脉综合征(ACS)中的临床意义及他汀类药物对ACS患者脑钠肽的影响。方法:以ACS患者78例和稳定型心绞痛患者(SAP)40例为研究对象,ACS患者被分为不稳定型心绞痛(UAP)组,40例、急性心肌梗塞(AMI)组,38例,测定其血清BNP、高敏C反应蛋白(hs-CRP)、肌钙蛋白I(TnI)水平,并选择ACS患者中60例随机分为他汀治疗组(30例)和常规对照组(30例),比较两组治疗4周后上述各指标的变化。结果:ACS组BNP、hs-CRP、TnI水平均明显高于SAP组(P<0.01),AMI组BNP、hs-CRP、TnI水平均明显高于UAP组(P<0.01),AMI组BNP水平与hs-CRP呈正相关(r=0.913,P<0.01)、与TnI呈正相关(r=0.526,P<0.01);与常规对照组比较,他汀治疗组治疗后BNP、hs-CRP水平明显下降(P<0.05)。结论:血清BNP水平与急性冠脉缺血的严重程度正相关。阿托伐他汀可显著降低BNP水平,提示其具有独立于降脂作用之外的改善心肌缺血作用。

Objectives To explore clinical significance of serum level of B-type natriuretic peptide （BNP） in patients with acute coronary syndrome （ACS） and the effect of atorvastatin on it. Methods： Seventy-eight patients with ACS and forty patients with stable angina pectoris （SAP） were study object. The ACS included acute myocardial infarction （AMI） （n=38） and unstable angina pectoris （UAP） （n=40）. To measure the serum levels of BNP, high sensitive C--reactive protein （hs--CRP） and troponin I （TnI） in all patients. The 60 ACS patients were randomly divided into the atorvastatin group （n= 30） and routine treatment group （n= 30）. Levels of serum BNP, hs--CRP, TnI were measured again on four weeks after treatment in the two subgroups. Results： Levels of serum BNP, hs--CRP, TnI were significantly higher in ACS group than those in SAP group （P〈0.01） and levels of serum BNP, hs--CRP, Tnl were sighificantly higher in AMI group than those in UAP group （P〈0.01）, BNP level were highly correlated with TnI （r=0. 526, P〈0. 01） and hs-CRP （r=0. 913, P〈0.01）. After four weeks＇ treat with atorvastatin, the decreasing concentration of BNP, hs--CRP, TnI were obtained in atorvastatin group, compared with routine treatment group （P〈0. 05）. Conclusion： Serum level of BNP may reflect degree of myocardial ischemia. Atorvastatin can decrease BNP level, suggesting its effect independent of lipid lowering action in ACS.