冠状动脉介入治疗对老年冠心病患者脑钠肽前体N-末端片段和高敏C反应蛋白水平的影响Influence of percutaneous coronary intervention on NT-proBNP and Hs-CRP levels of the elderly with coronary heart disease
田清平,刘梅林,霍勇,徐国宾
摘要(Abstract)：
目的通过测定冠心病患者介入治疗前后血浆脑钠肽前体N-末端片段(NT-proBNP)水平的变化,探讨冠状动脉介入治疗(PCI)对老年冠心病患者血浆NT-proBNP及高敏C反应蛋白(Hs-CRP)水平的影响。方法冠心病介入治疗组(PCI组)24例和单纯冠脉造影组(CAG组)30例,在术前、术后即刻、1h、24h以及72h分别测定血浆NT-proBNP及Hs-CRP水平。结果术前PCI组与CAG组的NT-proBNP水平差异无统计学意义。CAG组术前和术后NT-proBNP水平无显著变化。PCI组术后血浆NT-proBNP水平比术前明显升高,从术前的231.31±233.52pg/mL逐渐升高,至术后24h达到峰值663.75±614.93pg/mL,与术前相比差异具有统计学意义(P<0.05)。术后即刻、术后1h、24h和72h4个时间点PCI和CAG两组之间的差异均具有统计学意义。两组患者的Hs-CRP水平在术后72h较术前明显升高。结论PCI导致的短暂心肌缺血可引起血浆NT-proBNP水平升高,提示NT-proBNP可作为心肌缺血的监测指标并有助于老年人不典型心肌缺血的诊断。PCI及CAG术后72hHs-CRP升高,提示Hs-CRP与血管急性损伤所致炎症反应有关。
关键词(KeyWords)： 血管成形术,经腔,经皮冠状动脉;冠状动脉疾病;利钠肽,脑;C反应蛋白质
基金项目(Foundation):
作者(Author): 田清平,刘梅林,霍勇,徐国宾
参考文献(References)：
- [1]Suzuki T,Yamazaki T,Yazaki Y,et al.The role of the natriuretic peptide inthe cardiovascular system.Cardiovasc Res,2001,51:489-494.
- [2]de Lemos JA,MorrowDA,Bentley JH,et al.The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes.NEngl J Med,2001,345:1014-1021.
- [3]James SK,Lindahl B,Siegbahn A,et al.N-terminal probrain natriuretic peptide and other riskfactorsfor the separate prediction ofmortality and subsequent myocardial infarction in patients with unstable coronary artery disease.Aglobal utilization of strategies to open occluded arteries(GUSTO)IVsubstudy.Circulation,2003,108:275-281.
- [4]刘梅林,李继敏,胡大一,等.心绞痛患者血浆N-proBNP水平的变化及其临床意义.中华心血管病杂志,2004,32:497-500.
- [5]Karl J,Boryga A,Gallusser A,et al.Development of a novel,N-terminal-proBNP(NT-proBNP)assay with a low detection limit.Scand J Clin Lab Invest Suppl,1999,230:177-181.
- [6]高伟,王士雯,赵玉生.脑钠肽前体N末端片断在心血管病研究应用中的现状.中华心血管病杂志,2004,32:759-761.
- [7]Tateishi J,Masutani M,Ohyanagi M,et al.Transient increase in plasma brain(B-type)natriuretic peptide after percutaneous transluminal angioplasty.Clin Cardiol,2000,23:776-780.
- [8]Hama N,Itoh H,Shirakami G,et al.Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction.Circulation,1995,92:1558-1564.
- [9]Toth M,Vuorinen KH,Vuolteenaho O,HassinenIE,et al.Hypoxia stimulates release of ANP and BNP from perfused rat ventricular myocardium.AmJ Physiol,1994,266:11572-11580.