冠状动脉粥样硬化性心脏病患者血浆心钠素水平与早期心功能障碍关系的观测

The relationship between plasma atrial natriuretic peptide level and early cardiac dysfunction in patients with coronary artery disease

目的：明确心钠素能否作为冠状动脉粥样硬化性心脏病（冠心病）早期心功能障碍的预测指标。方法：随机入选经冠状动脉（冠脉）造影确诊正常及冠心病患者６０例，依据病变累及冠脉的支数分为４个亚组病变冠脉（０支、１支、２支和３支组）各１５例；左心导管及左室电影造影测定血流动力学参数；放免法测定血浆心钠素浓度。结果：左室射血分数随着冠脉病变程度加重逐渐降低，但各亚组间差异不显著（仅冠脉３支病变组与冠脉０支病变组比较Ｐ＜０．０５）；舒张功能参数亚组间差异显著，以时间常数为明显（Ｐ＜０．０１），它同冠脉狭窄积分呈正相关（ｒ＝０．７２，Ｐ＜０．０１）。心钠素同冠脉狭窄积分、时间常数呈正相关（ｒ＝０．５３～０．５７，Ｐ均＜０．０１）；同左室射血分数呈负相关（ｒ＝－０．３３，Ｐ＜０．０５）。结论：冠心病舒张功能障碍先于收缩功能障碍；心钠素是评价冠心病患者早期舒张功能障碍的一个良好指标。

Objective:To identify whether plasma atrial natriuretic peptide (ANP) level is an index for evaluating early cardiac dysfunction in patients with coronary artery disease.Methods:A total of 60 normal individuals and coronary artery disease patients were chosen at random,and the diagnosis was made by coronary arteriography.4 subgroups (0,1,2,3 branch lesion group)were divided basing on number of involved coronary artery branch,and each group consisted of 15 cases.Hemodynamic parameters were measured by left cardiac catheter and left ventricular cineangiography.Plasma ANP concentration was measured by radioimmunoassay.Results:LVEF decreased as number of diseased coronary artery branch increased,but there was no significant difference between subgroups (except 3 vs.0 lesion branch group, P <0 05);there were significant differences in diastolic function parameters between subgroups,especially T,which was positively correlated with stenosis score ( r =0 72, P <0 01).Plasma ANP levels were positively correlated with stenosis score,time constant ( r =0 53～0 57,both P <0 01),but negatively correlated with LVEF ( r =-0 33, P <0 05). Conclusions :Coronary artery disease impairs diastolic function prior to systolic function;ANP is an important index for evaluating early cardiac dysfunction in patients with coronary artery disease.