脑钠肽与不稳定型心绞痛患者左心功能相关性研究

Relationship between brain natriuretic peptide and left heart function in patients with unstable angina pectoris

目的研究血浆脑钠肽(BNP)水平与左心室舒张末期压力(LVEDP)在不稳定型心绞痛(UAP)患者中的变化规律,探讨左心功能的变化与BNP变化的相关性。方法选择57例冠状动脉造影(CAG)检查者为研究对象,CAG检查正常者12例作为对照组,45例UAP患者按Braunwald分级分为Ⅰ级组(16例)、Ⅱ级组(14例)和Ⅲ级组(15例)。所有患者采用多普勒超声心动图检测左心房前后径(LAD)、左心室舒张末期内径(LVEDd)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF)及E/A数值。通过左心室压力曲线测左心室舒张末期压力(LVEDP)。用酶联免疫吸附定量法测BNP的浓度。结果对照组、Ⅰ级组、Ⅱ级组、Ⅲ级组BNP和LVEDP水平组间两两比较差异均有统计学意义(P<0.05);其余各指标组间两两比较差异均无统计学意义(P>0.05)。BNP水平与LVEDP有明显的相关性(r=0.756,P<0.01)。结论 BNP可反映UAP患者心肌缺血的程度,在一定范围内可反映充血性心力衰竭的严重程度。

Objective To observe the changing rule of plasma level of brain natriuretic peptide（BNP） and left ventricular end-diastolic pressure（LVEDP）in patients with unstable angina pectoris（UAP）,and explore the correlation between the changes of left heart function and BNP. Methods Fifty-seven cases who underwent coronary angiography（CAG） examination were included.Twelve cases with normal CAG examination results as control group,forty-five patients with UAP were divided into grade Ⅰ group（n=16）,grade Ⅱ group（n=14） and grade Ⅲ group（n=15） according to the class of Braunwald.The left atrial diameter（LAD）,left ventricular end-diastolic diameter（LVEDd）,left ventricular posterior wall thickness（LVPWT）,interventricular septal thickness（IVST）,left ventricular ejection fraction（LVEF）and E/A were detected in all cases by Doppler echocardiography.The value of LVEDP was detected by record left ventricular pressure curves in all cases.The plasma concentration of BNP was measured by radioimmunoassay. Results There were significant differences in the plasma levels of BNP and LVEDP in control group,grade Ⅰ,Ⅱ,Ⅲ groups（P0.05）;the other indexes had no statistic difference in groups（P0.05）.The plasma level of BNP was obviously correlated with LVEDP in all cases（r= 0.756,P0.01）. Conclusion The level of BNP could reflect the severity of cardiac ischemia in patients with UAP,it could reflect the severities of congestive heart failure to some extend.