药物洗脱支架对稳定冠心病患者血浆B型脑利钠肽的影响

Effects of drug-eluting stents on B-type natriuretic peptide in patients with stable coronary artery disease

目的:初步探讨稳定型冠心病(CAD)患者静脉血浆B型利钠肽(BNP)水平在长期药物洗脱支架(DES)植入后的变化以及基线BNP水平与临床事件的关系。方法:研究入选了88例稳定CAD患者,均经冠脉造影(CAG)证实。以微粒子酶免分析法(化学发光法)测定所有入选者血BNP浓度。其中29例在DES植入后进行了CAG复查和BNP测定。随访1年时的死亡、非致死性急性冠脉综合征(ACS)、再次PCI、再次心血管原因入院等不良心血管事件。结果:BNP水平:冠脉造影Gensini评分>33组(44例)的显著高于Gensini评分≤33组(44例)的,P=0.0468。DES植入8月后BNP水平明显降低[(230.43±48.81)∶(149.33±17.49)pg/ml,P=0.0382]。平均随访10.5个月,BNP高水平组死亡、非致死性ACS、再入院和再次PCI率均显著高于低水平组(P=0.001)。结论:稳定CAD病变程度越重,BNP水平越高,而DES植入8月后BNP水平降低可能反映了心功能的改善;基线BNP水平对稳定CAD心血管事件可能有重要预测价值。

Objective：To observe the changes of BNP levels after drug-eluting stent （DES）implantation and to explore the prognostic effect of BNP levels on cardiovascular events in patients with stable coronary artery disease （CAD）.Methods：Between 2007 and 2009,a cohort study involving 88 patients with stable CAD in our hospital was conducted. All patients were proved by coronary angiography （CAG）. After DES implantation,CAG and BNP of 29 patients with stable CAD were measured again. Patients were followed-up one year.Results：In higher Gensini （CAG）scores group（44 cases）,the BNP levels increased than that of lower Gensini scores group（44 cases）,P=0.046.After PCI,BNP levels of 29 patients decreased[（230.43±48.81） pg/ml vs.（149.33±17.49）pg/ml,P=0.0382].After 10.5 months follow-up,patients with higher baseline BNP levels associated with significantly increase of death,nonfatal ACS,repeated PCI and rehospitalization （P=0.001）.Conclusion：Results confirms high BNP levels are associated with severity of myocardial ischemia and predict more adverse cardiovascular events in patients with stable CAD after drug-eluting stent implantation.