BNP與冠狀動(dòng)脈病變及心臟變時(shí)性相關(guān)性研究

林祖近等

[摘要]目的探討冠心病患者血漿腦鈉肽（BNP）與冠狀動(dòng)脈病變嚴(yán)重程度及心臟變時(shí)性的相關(guān)性。方法記錄冠心病患者血漿BNP水平及心臟變時(shí)性指標(biāo)，包括rHR和HRR，并記錄冠狀動(dòng)脈造影（CAG）結(jié)果，計(jì)算Gensini評(píng)分，對(duì)比分析無(wú)癥狀性心肌缺血、穩(wěn)定型心絞痛及不穩(wěn)定型心絞痛3組患者血漿BNP水平及心臟變時(shí)性指標(biāo)差異。評(píng)價(jià)血漿BNP水平與冠狀動(dòng)脈病變嚴(yán)重程度及心臟變時(shí)性指標(biāo)相關(guān)性。結(jié)果本研究共納入462例冠心病患者，單因素方差分析結(jié)果顯示各組間BNP水平差異均有統(tǒng)計(jì)學(xué)意義（均P<0.05）；無(wú)癥狀性心肌缺血與不穩(wěn)定型心絞痛心臟變時(shí)性指標(biāo)rHR比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。Person相關(guān)分析顯示，冠心病患者血漿BNP水平與冠狀動(dòng)脈病變Gensini評(píng)分呈正相關(guān)（r=0.43，P<0.05），與心臟變時(shí)性指標(biāo)rHR及HRR均呈負(fù)相關(guān)（r=-0.34，-0.40，均P<0.05）。結(jié)論冠心病患者血漿BNP與冠狀動(dòng)脈病變程度及心臟變時(shí)性指標(biāo)rHR和HRR密切相關(guān)，對(duì)于評(píng)價(jià)冠心病心臟功能的改變有重要的臨床價(jià)值。

[關(guān)鍵詞]冠心病；腦鈉肽；心臟變時(shí)性

中圖分類號(hào)：R541.4文獻(xiàn)標(biāo)識(shí)碼：A文章編號(hào)：1009_816X（2014）06_0470_04

[Abstract] Objective To investigate the correlation of degree of coronary artery lesion and chronotropic response in patients with coronary heart disease. Methods BNP and chronotropic response including rHR and HRR were recorded of patients with coronary heart disease， outcomes of coronary angiography （CAG） and the score of Gensini were also recorded. Contrastive analysis of BNP and chronotropic response of three groups， myocardial ischemia， stable angina pectoris （SAP） and unstable angina pectoris （UAP）， were taken and the correlation of degree of coronary artery lesion and chronotropic response was evaluated. Results A total of 462 patients with coronary heart disease were enrolled. Analysis of Variance showed there were significant differences of the level of BNP among the three groups （all P<0.05）. There were significant differences of rHR between the group of myocardial ischemia and UAP （P<0.05）. There was positive correlation between BNP and the score of Gensini （r=0.43，P<0.05）. There was negative correlations between BNP and rHR， so did BNP and HRR （r=-0.34，-0.40， all P<0.05）. Conclusions BNP， rHR， HRR， and degree of coronary artery lesion are closely related and valuable for the evaluation of cardiac function in patients with coronary heart disease.

[Key words] Coronary disease； Brain natriuretic peptide； Chronotropic response

腦鈉肽（brain natriuretic peptide，BNP）又稱B型利鈉肽（B_type natriuretic peptide），是利尿肽家族中最為重要的一員。早期已有研究提示血漿BNP水平可為心力衰竭、急性心肌梗死（acute myocardial infarction，AMI）及急性冠狀動(dòng)脈綜合征（acute coronary syndromes，ACS）的診斷及評(píng)估提供很大的幫助[1]。心臟變時(shí)性與心肌缺血程度密切相關(guān)，可反映心臟自主神經(jīng)功能狀態(tài)，亦可用于評(píng)價(jià)冠心病患者心臟功能的改變。臨床中關(guān)于冠心病患者血漿BNP水平、冠狀動(dòng)脈病變嚴(yán)重程度及心臟變時(shí)性相關(guān)性研究近年來(lái)開展較少。本文旨在分析冠心病患者血漿BNP水平與冠狀動(dòng)脈病變嚴(yán)重程度及心臟變時(shí)性的相關(guān)性，為冠心病臨床診斷提供一定的臨床參考。

1資料與方法

1.1一般資料：2008年1月至2013年12月間就診于臺(tái)州市中心醫(yī)院心內(nèi)科并接受冠狀動(dòng)脈造影檢查（coronary angiogram，CAG）的462例冠心病患者被納入本研究，診斷標(biāo)準(zhǔn)參照我國(guó)《冠狀動(dòng)脈粥樣硬化性心臟病診斷標(biāo)準(zhǔn)》2010版。……