女性冠状动脉粥样硬化性心脏病患者多巴酚丁胺超声心动图负荷试验前后血浆B型脑尿肽水平的变化及临床意义

Clinical significance and variation of plasma B-type natriuretic peptide levels before and after dobutamine stress echocardiography in women with coronary heart disease

目的观察女性冠状动脉粥样硬化性心脏病（冠心病）患者多巴酚丁胺超声心动图负荷试验（DSE）前后血浆B型脑尿肽水平变化（△BNP）及临床意义。方法入选女性疑似冠心病病例90例（除外心力衰竭），所有患者均行冠状动脉造影检查，分为正常组39例和冠心病组51例，1周内所有患者行DSE，分别在试验前后测定血浆BNP水平，比较两组DSE前后血浆BNP水平，比较不同冠状动脉病变程度患者DSE前后△BNP水平。结果冠心病组DSE后血浆BNP水平较DSE前显著升高（P〈0．01）；不同冠状动脉病变程度患者DSE前后△BNP水平存在差异，多支病变组高于单支和双支痛变组（P〈0．05），双支病变组高于单支病变组（P〈0.05）；当DSE前后ABNP的水平〉7．6pg／mL时，诊断冠心病的敏感性为82．4％，特异性为8712％，AUC为0．896，95％可信区间为0．814-0．951。结论DsE前后检测△BNP水平对女性冠心病诊断及评价冠心病病情具有重要临床意义。

[Objective] To observe clinical significance and variation of plasma B-type natriuretic peptide （△BNP） levels before and after dobutamine stress echocardiography （DSE） in women with coronary heart disease. [Methods ] Selected cases of women with suspected coronary heart disease in 90 cases （except for heart failure, blood BNP levels were normal）, all patients underwent coronary angiography, were divided into 39 cases of nor- mal group and 51 cases of coronary heart disease group. All patients underwent DSE were measured plasma BNP levels before and after the test, compared levels of plasma BNP before and after DSE in both groups after one week. The levels of A BNP before and after DSE in different degree of coronary artery lesions patients were compared. [Results ] The levels of plasma BNP after DSE in coronary heart disease group increased significantly （P〈0.01）. The levels of △BNP before and after DSE in different degree of coronary lesions patients was statisti- cally significant difference, multi-vessel disease group was higher than that of single and double operation lesion group （P 〈0.05）, double vessel disease group was higher than that of single vessel disease group （P 〈0.05）. When the levels of A BNP was 7.6 pg/mL, the sensibility value and specificity value of diagnosing CHD was 82.4% and 87.2%. Area under curve （AUC） was 0.896, and 95% confidence interval was 0.814-0.951. [Conclusion] Detection of the levels of ABNP before and after DSE in women with coronary heart disease patients with diagno- sis and evaluation has important clinical significance.