不稳定性冠心病病人血浆NT-proBNP水平与冠状动脉病变严重程度的关系探讨

Correlation between Plasma NT-proBNP Level and Severity of Patients with Unstable Coronary Artery Disease

目的探讨不稳定性冠心病病人参照SYNTAX评分原则确定的冠状动脉病变严重程度(SCAD)和急性冠状动脉事件(ACE)等影响因素与血浆N末端脑钠肽前体(NT-proBNP)水平的关系,分析脑钠肽(BNP)对不稳定性冠心病冠状动脉病变诊断和病人预后的预测价值。方法选取2013年1月—2016年6月住院行冠状动脉造影(CAG)并完成术前血浆NT-proBNP检测的不稳定型心绞痛和发生ACE的急性冠脉综合征病人共1293例,参考SYNTAX评分原则确定SCAD,通过Logistic回归来回顾性分析各影响因素和血浆NT-proBNP水平的相关性。结果不稳定性冠心病病人参照SYNTAX评分的SCAD和ACE都独立于其他危险因素与NT-proBNP水平呈正相关,在NT-proBNP界值1022 pg/mL的界值水平:ORSCAD=2.294,P=0.008;ORACE=3.122,P=0.001。分层和亚组分析的结果也是一致的。结论不稳定性冠心病病人通过CAG并参照SYNTAX评分原则确定的SCAD和ACE都独立于其他危险因素与病人血浆BNP水平有密切关系。不稳定性冠心病病人冠状动脉病变越严重血浆BNP水平越异常升高。持续高BNP状态可以揭示心脏功能恶化并能够预测不良心脏事件发生。

Objective To analyze the correlations between severity of coronary artery disease(SCAD),acute coronary events(ACE)and plasma N-terminal pro Brain Natriuretic Peptide(NT-proBNP)concentration in hospitalized unstable coronary artery disease patients.Methods From January 2013 to June 2016,one thousand two hundred and ninety-three unstable coronary artery disease patients who had examined coronary angiography were selected,including unstable angina and acute coronary syndrome with acute coronary events.The severity of coronary artery disease was estimated referring to SYNTAX score.The correlation between the influence factors and plasma NT-proBNP level was analyzed by logistic regression.Results Severity of coronary artery disease referring to SYNTAX score and acute coronary events both correlated positively well with plasma NT-proBMP level.The NT-proBNP critical value was 1022 pg/mL,ORSCAD=2.294,P=0.008;ORACE=3.122,P=0.001.Further stratification and subgroup analyses also showed the unanimous outcomes.Conclusion Severity of coronary artery disease referring to SYNTAX score and acute coronary events both correlate independently well with NT-proBNP level in hospitalized unstable CAD patients.The more serious the coronary lesions means the more abnormally elevated plasma BNP level.High BNP level may sngest deteriorative cardiac function and terrible prognosis.