心房颤动时脑钠肽来源的探讨

Source of brain natriuretic peptide during atrial fibrillation

目的:通过对比心功能正常的心房颤动及频发室性早搏患者血浆脑钠肽(BNP)水平的差异,探讨心房颤动时BNP的来源。方法:采用化学发光法分别检测47例孤立性心房颤动(房颤组)、43例频发室性早搏患者(室早组),以及50例健康体检者(健康对照组)的血浆BNP浓度,并采用超声心动图检测三组的左房、左室舒张末内径、左室射血分数,另外对室早组及房颤组行动态心电图检查。结果:1、房颤组、室早组无论治疗前,治疗成功与失败24h平均心室率均无显著差异;2、房颤组、室早组血浆BNP水平明显高于健康对照组[132.5(78.2,154.3)pg/ml比118.6(66.5,132.3)pg/ml比36.5(14.6,48.5),P<0.05),房颤组血浆BNP水平又明显高于室早组(P<0.05);3、经成功治疗后房颤组、室早组的血浆BNP显著下降,与健康对照组无显著差异(P>0.05);4、室早治疗失败组BNP水平显著下降,与健康对照组无显著差异(P>0.05),房颤治疗失败组BNP水平显著下降,但仍显著高于健康对照组[70.5(42.5,90.3)pg/ml比36.5(14.6,48.5)pg/ml](P<0.05);结论:心功能正常的频发室性早搏及心房颤动均伴有血浆BNP水平升高,在心室率无显著差异情况下,心房颤动组的BNP水平显著高于室性早搏组,且房颤治疗失败组的BNP水平不能降至正常水平,推测心房颤动时BNP水平的升高有心房因素的参与,是心房因素与心室因素共同作用的结果。

Objective： To explore source of brain natriuretic peptide （BNP） during atrial fibrillation （AF）. Methods： Plasma BNP concentrations of 47 isolated AF patients （AF group）, 43 frequent premature ventricular contractions （PVC） patients （PVC group） and 25 healthy subjects （healthy control group） were measured by chemiluminescence method. Left atrial and ventricular end- diastolic dimension and left ventricular ejection fraction were measured in three groups using echocardiography. Patients of AF group and PVC group underwent dynamic electrocardiography examination. Results： 1. There was no significant difference in 24 h mean ventricular rate between AF group and PVC group and before and after treatment （P〉0. 05） ; 2. Plasma BNP levels in AF group and PVC group were sig- nificantly higher than that of healthy control group （-132.5 （78.2, 154. 3） pg/ml vs. 118.6 （66.5, 132.3） pg/ml vs. 36. 5 （14. 6, 48.5） pg/ml] （P〈0.05）, and plasma BNP level of AF group was significantly higher than that of PVC group （P〈0.05）; 3. After successful treatment, the plasma BNP levels of AF and PVC groups significantly decreased and were no significant difference compared with that of healthy control group （P〉0.05）; 4. in PVC treatment failure group, the BNP level significantly decreased to level that was no significant difference compared with that of healthy control group （P〉0.05） after treatment, but in AF treatment failure group, the BNP level also significantly decreased, but still significantly higher than that of healthy control group [-70.5 （ 42.5, 90.3） pg/ml vs. （36.5 （14.6, 48.5） pg/ml] after treatment, P〈0.05. Conclusion： Both frequent PVC and AF groups with normal cardiac function all accompany plasma BNP level increase, BNP level of AF group is significantly higher than that of PVC group, furthermore BNP level of AF treatment failure group can＇t decrease to normal level under ventricular rate without significant different, suggest that atrial factor is involved in increase of BNP level in AF, which is the common results of atrial and ventricular factors.