不稳定型心绞痛患者冠脉介入术前后N末端脑钠肽前体水平的变化

Changes of N-terminal pro-brain natriuretic peptide in unstable angina pectoris undergone with percutaneous coronary intervention

目的 观察冠脉介入前、后不稳定型心绞痛（UAP）患者N末端脑钠肽前体（NT-proBNP）水平变化,探讨心肌缺血与NT-proBNP的关系.方法 选择心功能正常的UAP患者75例,胸痛症状无发作3 d以上时行冠状动脉造影检查,病变适宜者接受经皮冠状动脉介入治疗.术前及术后16～24 h进行超声心动图检查和血浆NT-proBNP浓度测定,术后72 h复查血浆NT-proBNP水平.结果 单纯冠脉造影（CAG组）37例,经皮冠状动脉介入治疗（PCI组）38例,其中单支病变28例,包括左冠状动脉前降支置入支架（LAD组）18例、右冠状动脉或回旋支置入支架（非LAD组）10例.CAG组术前和术后16～24 h的NT-proBNP水平及左室射血分数（LVEF）无明显变化（P＞0.05）;PCI组术后16～24 h的血浆NT-proBNP浓度高于术前（P＜0.05）,LVEF较术前降低,但差异无统计学意义（P＞0.05）;LAD组的NT-proBNP升高幅度大于非LAD组（P＜0.05）,两组术后72 h的NT-proBNP水平均低于术前（P＜0.05）.结论 在心功能正常且无明显改变的情况下,UAP患者介入治疗后血浆NT-proBNP浓度暂时升高,可能与术中球囊扩张所致的一过性心肌缺血有关.心肌缺血是刺激NT-proBNP分泌增多的重要因素.

Objective To observe the changes of plasma N-terminal pro-brain natriuretic poptide （NT- proBNP） in unstable angina pectoris （UAP） underwent with coronary intervention, and evaluate the association between ischemic and NT-proBNP. Methods We enrolled a total of 75 patients with UAP and normal left ventricular function. Coronary angiography（CAG） for all patients and percutaneous coronary intervention （PCI） for part patients with suitable conditions were performed 3 days or above after the last chest pain. Plasma NT-proBNF and echocardiography were determined before and 16-24 hours after intervention. NT-proBNP was measured again 72 hours post intervention. Results 37 patients with CAG and 38 with PCI. The later contained 28 patients with one-vessel coronary disease, including 18 accepted stentt implantation in left anterior descending coronary artery （LAD group） and 10 in left circumflex or right coronary artery （non-LAD group）. No significant change in NT- proBNP and LVEF were noted before and 16-24 hours after simple CAG（P〉0.05）. NT-proBNP concentration was higher 16-24 hours after PCI than before （P〈0.05）, some decrease in left ventricular ejection fraction （LVEF） was not statistically significant （P〉0.05）. NT-proBNP showed a larger increase in the LAD group compared to the non-LAD group （P〈0.05）. NT-proBNP 72 hours post intervention was markedly lower than before in all patients （P〈0.05）. Conclusion Patients with UAP and preserved cardiac function have higher NT-proBNP levels after PCI, which is related to myocardial ischemia induced by balloon inflation during PCI. Myocardial ischemia is probably an important stimulus for NT-proBNP release.