风湿性二尖瓣狭窄瓣膜置换前后NT-proBNP浓度的变化

Changes in N-terminal pro-B type natriuretic peptide concentrations in rheumatic mitral stenosis undergoing valve replacement

目的探讨风湿性二尖瓣狭窄患者瓣膜置换术前后血浆氨基末端B型钠尿肽前体(NT-proBNP)浓度的动态变化及NT-proBNP浓度对术后转归的预测价值。方法检测42例风湿性二尖瓣狭窄施行心瓣膜置换术的患者在术前和术后1、3、12、30d血浆NT-proBNP浓度,分析术前NT-proBNP浓度与心功能分级(NYHA)、瓣膜狭窄程度(MVA)、左室射血分数(LVEF)及房颤的关系,比较手术前后NT-proBNP的差异及变化规律,评价血浆NT-proBNP浓度对手术转归的预测价值。结果术前血浆NT-proBNP浓度与心功能、房颤呈正相关(r=0.69,P<0.01;r=0.71,P<0.01),与瓣膜开口面积、LVEF呈负相关(r=―0.48,P<0.01;r=―0.35,P<0.01)。术后第1天血浆NT-proBNP浓度急剧升至峰值,第3天至第12天逐渐降至接近术前水平,第30天降至术前水平以下。术后ICU治疗时间、总住院时间和强心药应用时间与术前、术后第1天NT-proBNP浓度无明显相关性,与术后第3天NT-proBNP浓度呈正相关。术后第3天NT-proBNP浓度较术后第1天下降50%以上的患者心力衰竭发生率明显低于下降小于50%的患者(P<0.01)。结论动态监测心脏瓣膜置换术后NT-proBNP浓度对评估术后心脏功能和判断预后有一定价值。

Objective To investigate the changes in NT-proBNP concentrations in rheumatic mitral stenosis undergoing valve replacement（VR）and the impact of the NT-proBNP concentrations on valve surgical outcome.Methods NT-proBNP assay was performed with electrochemiluminescence in 42 patients with rheumatic mitral stenosis undergoing valve replacement before VR,1,3,12,30 d after VR.The correlations between preoperative NT-proBNP concentrations and the grade of heart function（NYHA）,mitral vavle area（MVA）,left ventricular ejection fraction（LVEF）and atrial fibrillation were analyzed.Results The preoperative NT-proBNP concentrations correlated closely to NYHA（r=0.69,P0.01）,atrial fibrillation（r=0.71,P0.01）,MVA（r=-0.48,P0.01）and LVEF（r=-0.35,P0.01）.The NT-proBNP concentrations increased sharply to peak 1 day after VR,and then decreased gradually to approach the baseline from 3 days to 12 days and below the baseline 30 days after VR.NT-proBNP concentrations of first day after operation and preparation were not associated with the time of stay in intensive care unit（ICU）,hospital,inotropic support.NT-proBNP concentrations of third days after operation showed a significant influence on the postoperative outcome.Patients with postoperative NT-proBNP decreasing more than 50% from first day to third day showed a significant lower incident of postoperative heart failure compared with patients with postoperative NT-proBNP decreasing less than 50%（P0.01）.Conclusion Dynamic monitoring postoperative NT-proBNP concentrations is useful for evaluating heart function and surgical outcome after valve replacement.