老年冠状动脉粥样硬化性心脏病患者B型脑钠肽与冠状动脉病变程度的关系
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摘要
目的探讨老年冠状动脉粥样硬化性心脏病(冠心病)患者B型脑钠肽(BNP)与冠状动脉病变程度的关系。方法选取2014年1月至2016年6月于首都医科大学附属北京安贞医院因胸痛症状就诊的年龄≥60岁的老年心内科住院患者200例为研究对象。根据本院冠状动脉CT或冠状动脉造影检查结果分为冠心病组和对照组,各100例。冠心病组分为单支病变组(41例)、双支病变组(37例)、多支病变组(22例)和复杂病变组(35例,包括多支血管病变)。比较各组的基线临床特征和同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、BNP水平。结果各组年龄、体重指数、吸烟史、高血压史、收缩压、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸及超声心动图指标差异均无统计学意义(均P> 0. 05)。单支病变组、双支病变组、多支病变组、复杂病变组Hcy、hs-CRP、BNP水平[(150±9)、(155±10)、(166±13)、(176±9)ng/L比(71±4)ng/L]高于对照组,差异均有统计学意义(均P <0.05)。结论 BNP水平是冠心病患者冠状动脉病变严重程度的预测指标。
Objective To explore the relation between brain natriuretic peptide(BNP) and severity of coronary artery lesion in elderly patients with coronary atherosclerotic heart disease( CHD). Methods From January 2014 to June 2016, 200 hospitalized elderly patients( ≥60 years old) with chest pain were enrolled in Beijing Anzhen Hospital, Capital Medical University. According to the results of coronary CT or angiography, the patients were divided into CHD group and control group, with 100 cases in each group. The CHD group was divided into single vessel disease group( n= 41), double vessel disease group( n = 37), multi-vessel disease group(n = 22) and complex disease group(n = 35, including multi-vessel disease). Baseline clinical characteristics,homocysteine(Hcy), high sensitive C-reactive protein(hs-CRP) and BNP levels were analyzed. Results There were no significant differences of age, body mass index, smoking history, hypertension history, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride,low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum uric acid and echocardiographic indexes among groups( P > 0. 05). Levels of Hey, hs-CRP and BNP [(150 ±9),(155 ±10),( 166 ± 13),(176 ±9)ng/L vs(71 ±4)ng/L] in the single vessel disease group,double vessel disease group, multi-vessel disease group and complex disease group were higher than those in the control group(P <0.05). Conclusion BNP is a predictor of the severity of coronary artery disease in CHD patients.
Objective To explore the relation between brain natriuretic peptide(BNP) and severity of coronary artery lesion in elderly patients with coronary atherosclerotic heart disease( CHD). Methods From January 2014 to June 2016, 200 hospitalized elderly patients( ≥60 years old) with chest pain were enrolled in Beijing Anzhen Hospital, Capital Medical University. According to the results of coronary CT or angiography, the patients were divided into CHD group and control group, with 100 cases in each group. The CHD group was divided into single vessel disease group( n= 41), double vessel disease group( n = 37), multi-vessel disease group(n = 22) and complex disease group(n = 35, including multi-vessel disease). Baseline clinical characteristics,homocysteine(Hcy), high sensitive C-reactive protein(hs-CRP) and BNP levels were analyzed. Results There were no significant differences of age, body mass index, smoking history, hypertension history, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride,low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum uric acid and echocardiographic indexes among groups( P > 0. 05). Levels of Hey, hs-CRP and BNP [(150 ±9),(155 ±10),( 166 ± 13),(176 ±9)ng/L vs(71 ±4)ng/L] in the single vessel disease group,double vessel disease group, multi-vessel disease group and complex disease group were higher than those in the control group(P <0.05). Conclusion BNP is a predictor of the severity of coronary artery disease in CHD patients.
引文
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[9]刘家祎,晏子旭,张楠,等.胸腹联合胸痛三联CT血管造影扫描对急诊胸痛患者心血管疾病诊断的价值[J].中国医药,2017,12(5):711-715. DOI:10. 3760/cma. j. issn. 1673-4777.2017.05.017.Liu JY, Yan ZX, Zhang,et al. Application value of triple rule-out CT angiography in emergency chest pain examination[J].China Medicine, 2017,12(5):711-715. DOI:10. 3760/cma. j.issn. 1673-4777.2017.05.017.
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[11]刘妍,杜俣,周玉杰,等.老年瓣膜性心脏病合并冠状动脉粥样硬化性心脏病患者的临床特点和危险因素及治疗现状分析[J].中国医药,2018,13(5):641-644.DOI:10.3760/j.issn.1673-4777.2018.05.001.Liu Y, Du Y, Zhou YJ, et al. Clinical characteristics, risk factors and treatment strategies of valvular heart disease with coronary atherosclerotic heart disease in elderly patients[J]. China Medicine,2018,13(5):641-644. DOI:10. 3760/j. issn. 1673-4777. 2018.05.001.
[12] Zheng JL, Lu L, Hu J, et al. Increased serum YKL-40 and C-reactive protein levels are associate with angiographic lesion progression in patients with coronary artery disease[J]. Atherosclerosis, 2010,210(2):590-595. DOI:10.1016/j. atherosclerosis.2009.12.016.
[13] Costello-Boerrigter LC, Lapp H, Boerrigter G, et al. Secretion of probormone of B-type natriuretic peptide, proBNP1-108, is increased in heart failure[J]. JACC Heart Fail, 2013,1(3):207-212. DOI:10.1016/j.jchf.2013.03.001.
[14] Dallmeier D, Pencina MJ, Rajman I, et al. Serial measurements of N-terminal pro-brain natriuretic peptide in patients with coronary heart disease[J]. PLoS One, 2015,10(1):e0117143. DOI:10.1371/journal. pone.0117143.
[15] Jefferis BJ, Whincup PH, Lennon LT, et al. Physical activity in older men:longitudinal associations with inflammatory and hemostatic biomarkers, N-terminal pro-brain natriuretic peptide,and onset of coronary heart disease and mortality[J]. J Am Geriatr Soc, 2014,62(4):599-606. DOI:10. 1111/jgs. 12748.
[16] Funke-Kaiser A, Mann K, Colquhoun D, et al. Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients:the LIPID study[J]. Int J Cardiol, 2014,172(2):411-418. DOI:10.1016/j. ijcard. 2014.01.064.
[17]汪磊,洪飞.重组人脑利钠肽对老年急性失代偿性心力衰竭患者BNP和肾功的影响及疗效研究[J].实用药物与临床,2017,20(12):1388-1391. DOI:10.14053/j. cnki. ppcr. 201712010.Wang L, Hong F. Effects of recombinant human brain natriuretic peptide on BNP and renal function in elderly patients with acute decompensated heart failure[J]. Practical Pharmacy and Clinical Remedies, 2017,20(12):1388-1391. DOI:10. 14053/j. cnki.ppcr. 201712010.
[18] Hasegawa,Asakura M, Eguchi K, et al. Plasma B-type natriuretic peptide is a useful tool for assessing coronary heart disease risk in a Japanese general population[J]. Hypertens Res, 2015,38(1):74-79. DOI:10.1038/hr.2014.123.
[2] Kuwahara K, Nakagawa Y, Nishikimi T. Cutting edge of brain natriuretic peptide(BNP)research-the diversity of BNP immunoreactivity and its clinical relevance[J]. Circ J, 2018,82(10):2455-2461. DOI:10.1253/circj. CJ-18-0824.
[3] Oremus M, Don-Wauchope A, McKelvie R, et al. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure[J]. Heart Fail Rev, 2014,19(4):471-505. DOI:10.1007/s10741-014-9439-6.
[4] Cao ZP, Xue JJ, Zhang Y, et al. Differential expression of B-type natriuretic peptide between left and right ventricles, with particular regard to sudden cardiac death[J]. Mol Med Rep, 2017, 16(4):4763-4769. DOI:10.3892/mmr.2017.7136.
[5]陈简庆,张民乐,吴伟军.冠心病心力衰竭患者血尿酸、脑钠肽、高敏C反应蛋白与左室射血分数的相关性分析[J].实用医学杂志,2012,28(2):239-240. DOI:10.3969/j.issn. 1006-5725.2012.2.027.Chen JQ, Zhang ML, Wu WJ. Correlations between blood uric acid and BNP and hs-CRP and ejection fraction in CAD patients[J].The Journal of Practical Medicine, 2012,28(2):239-240. DOI:10.3969/j. issn. 1006-5725.2012.2.027.
[6]张圆,吴晓丹,杨勇.心肌缺血再灌注损伤作用机制及非药物性治疗研究进展[J].中国医药,2017,12(5):787-791.DOI:10.3760/cma. j. issn. 1673-4777.2017.05.036.Zhang Y, Wu XD, Yang Y. Advance in mechanisms and nonpharmacotherapies of myocardial ischemia-reperfusion injury[J].China Medicine, 2017,12(5):787-791. DOI:10. 3760/cma. j.issn. 16734777.2017.05.036.
[7]周晓斌.冠心病患者血浆BNP及hs-CRP水平变化与冠状动脉病变程度的关系研究[J].河北医学,2015,20(7):1070-1073.DOI:10.3969/j. issn. 1006-6233.2015.07.005.Zhou XB. Relationship between plasma brain natriuretic peptide and high-sensitivity CRP in patients with CHD[J]. Hebei Medicine,2015,20(7):1070-1073. DOI:10. 3969/j. issn. 1006-6233.2015.07.005.
[8]高润霖,吴宁,胡大一,等.心血管病治疗指南和建议[M].北京:人民军医出版社,2004:57-58.Gao RL, Wu N, Hu DY, et al. Guidelines and recommendations for cardiovascular disease treatment[M]. Beijing:People's Medical Publishing House, 2004:57-58.
[9]刘家祎,晏子旭,张楠,等.胸腹联合胸痛三联CT血管造影扫描对急诊胸痛患者心血管疾病诊断的价值[J].中国医药,2017,12(5):711-715. DOI:10. 3760/cma. j. issn. 1673-4777.2017.05.017.Liu JY, Yan ZX, Zhang,et al. Application value of triple rule-out CT angiography in emergency chest pain examination[J].China Medicine, 2017,12(5):711-715. DOI:10. 3760/cma. j.issn. 1673-4777.2017.05.017.
[10] Sanchez LD, McGillicuddy DC, Volz KA, et al. Effect of two different FDA-approved D-dimer assays on resource utilization in the emergency department[J]. Acad Emerg Med, 2011,18(3):317-321. DOI:10.1111/j. 1553-2712.2010.00973.x.
[11]刘妍,杜俣,周玉杰,等.老年瓣膜性心脏病合并冠状动脉粥样硬化性心脏病患者的临床特点和危险因素及治疗现状分析[J].中国医药,2018,13(5):641-644.DOI:10.3760/j.issn.1673-4777.2018.05.001.Liu Y, Du Y, Zhou YJ, et al. Clinical characteristics, risk factors and treatment strategies of valvular heart disease with coronary atherosclerotic heart disease in elderly patients[J]. China Medicine,2018,13(5):641-644. DOI:10. 3760/j. issn. 1673-4777. 2018.05.001.
[12] Zheng JL, Lu L, Hu J, et al. Increased serum YKL-40 and C-reactive protein levels are associate with angiographic lesion progression in patients with coronary artery disease[J]. Atherosclerosis, 2010,210(2):590-595. DOI:10.1016/j. atherosclerosis.2009.12.016.
[13] Costello-Boerrigter LC, Lapp H, Boerrigter G, et al. Secretion of probormone of B-type natriuretic peptide, proBNP1-108, is increased in heart failure[J]. JACC Heart Fail, 2013,1(3):207-212. DOI:10.1016/j.jchf.2013.03.001.
[14] Dallmeier D, Pencina MJ, Rajman I, et al. Serial measurements of N-terminal pro-brain natriuretic peptide in patients with coronary heart disease[J]. PLoS One, 2015,10(1):e0117143. DOI:10.1371/journal. pone.0117143.
[15] Jefferis BJ, Whincup PH, Lennon LT, et al. Physical activity in older men:longitudinal associations with inflammatory and hemostatic biomarkers, N-terminal pro-brain natriuretic peptide,and onset of coronary heart disease and mortality[J]. J Am Geriatr Soc, 2014,62(4):599-606. DOI:10. 1111/jgs. 12748.
[16] Funke-Kaiser A, Mann K, Colquhoun D, et al. Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients:the LIPID study[J]. Int J Cardiol, 2014,172(2):411-418. DOI:10.1016/j. ijcard. 2014.01.064.
[17]汪磊,洪飞.重组人脑利钠肽对老年急性失代偿性心力衰竭患者BNP和肾功的影响及疗效研究[J].实用药物与临床,2017,20(12):1388-1391. DOI:10.14053/j. cnki. ppcr. 201712010.Wang L, Hong F. Effects of recombinant human brain natriuretic peptide on BNP and renal function in elderly patients with acute decompensated heart failure[J]. Practical Pharmacy and Clinical Remedies, 2017,20(12):1388-1391. DOI:10. 14053/j. cnki.ppcr. 201712010.
[18] Hasegawa,Asakura M, Eguchi K, et al. Plasma B-type natriuretic peptide is a useful tool for assessing coronary heart disease risk in a Japanese general population[J]. Hypertens Res, 2015,38(1):74-79. DOI:10.1038/hr.2014.123.