NT-proBNP对心脏介入治疗的临床价值

Clinical Value of NT-proBNP in Cardiovascular Interventional Treatment

[目的]观察冠心病患者血浆氨基末端B型利钠肽前体（NT-proBNP）对血管病变数目及程度的预测价值，探讨血浆NT-proBNP在介入治疗前和治疗后一年的浓度变化情况，并评估患者预后。[方法]选取经冠状动脉造影证实的冠心病患者467例，按血管狭窄程度将患者分为轻度、中度、重度或闭塞组，依据支架植入情况分为单支、双支、左主干或三支病变组，抽取其静脉血，采用电化学发光免疫分析法，通过Spearman等级相关分析研究血浆NT-proBNP与血管狭窄程度及病变支数的关系。同时将所有植入支架的患者随访一年，分别检测支架术前、术后24 h、6个月及一年的血浆NT-proBNP浓度，用方差分析比较不同时间血浆NT-proBNP水平的变化情况。[结果]Spearman等级相关分析显示血浆NT-proBNP水平与血管病变支数显著相关（ P ＜0．05），与病变狭窄程度亦相关（ P ＜0．01）。支架术后患者6个月血浆Log NT-proBNP浓度[（1．99＆#177;0．53） pg/mL]及一年的浓度值[（1．95＆#177;0．50） pg/mL]分别与术前[（2．41＆#177;0．50） pg/mL]相比显著降低（ P ＜0．05）。[结论]血浆NT-proBNP可能是预测冠心病患者血管病变数目、严重程度，及监测患者预后的新型生化标记物，可以指导临床医生更好地把握介入治疗的指征。

[Objective]To observe the predictive value of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） for the number and extent of vascular lesions in coronary heart disease patients ,and to explore the changes of plasma NT-proBNP before and 1 year after interventional treatment ,and to assess the prognosis of patients .[Methods] Totally 467 patients with coronary artery disease confirmed by coronary angiography were selected .Patients were divided into mild ,moderate ,severe or occlusion groups according to the degree of stenosis .According to stent implantation ,all patients were divided into single ,double ,left main or three-ves-sel disease groups .Venous blood was collected .Electrochemiluminescence immunoassay was used .The rela-tionship of plasma NT-proBNP with the degree of stenosis and the number of diseased vessels was studied by Spearman rank correlation analysis .All stented patients were followed for 1 year .Plasma NT-proBNP level was measured before ,24 hours ,6 months and 1 year after stenting .The change of plasma NT-proBNP level at different time was compared by using the analysis of variance .[Results]Spearman rank correlation analysis showed that plasma NT-proBNP level was significantly correlated with the number of diseased vessels （ P ＆lt;0 .05） ,and also correlated with the degree of stenosis （ P ＆lt;0 .01） .Plasma Log NT-proBNP levels of patients 6 months and 1 year after stent implantation were significantly lower than those before stent implantation [（1 .99 ＆#177; 0 .53）pg/mL and （1 .95 ＆#177; 0 .50） pg/mL vs .（2 .41 ＆#177; 0 .50） pg/mL]（ P ＆lt;0 .05） .[Conclusion] Plas-ma NT-proBNP may be a new biochemical marker for predicting the number and severity of vascular lesions and monitoring the prognosis of patients with coronary heart disease ,so it can guide the clinicians to better grasp the indication for interventional treatment .