经皮二尖瓣球囊扩张术对风湿性二尖瓣狭窄患者血浆B型钠尿肽水平的影响

Influence of percutaneous balloon mitral valvuloplasty on level of plasma type B natriuretic peptide in patients with rheumatic mitral stenosis

目的探讨经皮二尖瓣球囊扩张术(PBMV)对风湿性二尖瓣狭窄患者血浆B型钠尿肽(BNP)水平的影响。方法选取行PBMV的患者20例设为观察组,检测术前、术后20 min及24 h的血浆BNP水平;另选择健康体检者20例为对照组,检测血浆BNP水平,分析其与血流动力学参数的相关性。结果观察组术后20 min、24 h血浆BNP浓度逐渐下降,各时间点之间差异有统计学意义(P<0.01);组间比较,观察组术前及术后不同时间点BNP浓度均显著高于对照组(P<0.01)。术后20 min,观察组肺动脉收缩压(PAP)和左心房压(MLAP)、左心房内径(LAD)较术前降低,二尖瓣口心面积(MVA)较术前增加(P<0.01),右心房压(MRAP)无显著变化(P>0.05);术后24 h,MVA较术前增加,LAD减少(P<0.01),与术后20 min比较无显著变化(P>0.05)。术前及术后20 min,观察组血浆BNP浓度与PAP(r=0.473、0.457,P<0.05或P<0.01)和MLAP(r=0.446、0.457,P<0.05)呈正相关。结论风湿性二尖瓣狭窄患者血浆BNP浓度与PAP和MLAP呈正相关,BNP水平变化对评价PBMV后左心房功能具有参考价值。

Objective To explore the influence of percutaneous balloon mitral valvuloplasty（ PBMV） on level of plasma type B natriuretic peptide（ BNP） in patients with rheumatic mitral stenosis. Methods A total of 20 patients underwent PBMV were selected as observation group,and their plasma BNP levels before operation,20 min and 24 h after operation were detected. Another 20 healthy people underwent physical examination were selected as control group,and their plasma BNP levels were also detected. The relationships between BNP level and hemodynamic parameters were analyzed. Results In the observation group,BNP level decreased gradually 20 min and 24 h after operation,and there were significant differences among different time points（ P〈0. 01）. The intergroup comparison showed that observation group was significantly higher than control group in BNP level at different time points before and after operation（ P〈0. 01）. Twenty minutes after operation,pulmonary artery systolic pressure（ PAP）,mean left atrial pressure（ MLAP） and left atrial diameter（ LAD） reduced significantly in observation group,while mitral valve orifice area（ MVA） increased significantly when compared with that before operation（ P〈0. 01）,but there was no significant difference in mean right atrial pressure（ MRAP） before and after operation（ P〉0. 05）,whereas24 h after operation,MVA increased significantly and LAD decreased significantly（ P〈0. 01） than those before operation,and there was no significant difference when compared with those 20 min after operation（ P〉0. 05）. Before and 20 min after operation,BNP level was positively associated with PAP（ r = 0. 473,0. 457,P〈0. 05 or P〈0. 01） and MLAP（ r = 0. 446,0. 457,P〈0. 05） in observation group,but there was no association between BNP level and all indexes 24 h after operation（ P〉0. 05）. Conclusion BNP level is positively associated with PAP and MLAP in patients with rheumatic mitral stenosis,and its change is of great referring value for the evaluation of left atrial function after PBMV.