脑钠肽与冠状动脉狭窄的关系：衰老的影响

[Relationship between brain natriuretic peptide and coronary stenosis: influence of aging].

作者信息

Suzuki Nobuaki, Mori Hideki, Hazama Minoru, Takahashi Kazuhiro, Moriya Manabu, Yano Katsusuke

机构信息

Department of Cardiology, Japanese Red Cross Nagasaki Genbaku Hospital, Morimachi 3-15, Nagasaki, Nagasaki 852-8511.

出版信息

J Cardiol. 2004 Mar;43(3):117-22.

PMID:15067799

Abstract

OBJECTIVES

The relationship between brain natriuretic peptide (BNP) and coronary stenosis, and the utility of BNP for the prediction of coronary stenosis were investigated.

METHODS

This study included 100 consecutive patients (48 men, 52 women, mean age 65.8 +/- 9.9 years) who underwent elective cardiac catheterization for the diagnosis of coronary stenosis without other heart diseases (heart failure, valvular heart disease, cardiomyopathy, sick sinus syndrome), and E/A was recorded by echocardiography. The relationship between coronary stenosis, left ventricular ejection fraction by left ventriculography, left ventricular end-diastolic pressure, E/A, left ventricular stroke volume index by echocardiography and BNP were investigated.

RESULTS

Thirty-nine patients revealed coronary stenosis > or = 75% (CS), and 6 patients had chronic total occlusion. In the CS(+) group, BNP and left ventricular end-diastolic pressure were elevated significantly (50.7 +/- 48.5 vs 22.1 +/- 21.6 pg/ml, p < 0.05; 9.2 +/- 5.3 vs 6.4 +/- 3.4 mmHg, p < 0.05). In logistic regression analysis, BNP and left ventricular end-diastolic pressure had significant correlations with CS(+), independent of age, systolic blood pressure, E/A and left ventricular ejection fraction (p = 0.007, p = 0.05, respectively). Prognostic values of BNP (> 20 pg/ml) for the diagnosis of CS(+) were sensitivity of 79%, and specificity of 61% (p < 0.005). In the CS(-) group, the patients showing BNP > 20 pg/ml were older than the patients showing BNP < or = 20 pg/ml (68.4 +/- 8.5 vs 60.0 +/- 9.4, p < 0.05). Therefore, the prognostic values were reduced (sensitivity 78%, specificity 82%, p < 0.005) in the younger group (age < 65, n = 42). Even in patients with coronary stenosis but without chronic total occlusion, both BNP and left ventricular end-diastolic pressure were elevated significantly compared with the patients without coronary stenosis (22.1 +/- 21.6 vs 44.0 +/- 43.2 pg/ml, p < 0.01; 6.4 +/- 3.4 vs 9.1 +/- 5.2 mmHg, p < 0.01).

CONCLUSIONS

Plasma BNP levels are useful markers for detecting coronary stenosis, especially in younger patients.

摘要

目的

研究脑钠肽（BNP）与冠状动脉狭窄之间的关系，以及BNP对冠状动脉狭窄的预测效用。

方法

本研究纳入100例连续接受选择性心导管检查以诊断冠状动脉狭窄且无其他心脏病（心力衰竭、心脏瓣膜病、心肌病、病态窦房结综合征）的患者（48例男性，52例女性，平均年龄65.8±9.9岁），并通过超声心动图记录E/A。研究冠状动脉狭窄、左心室造影测得的左心室射血分数、左心室舒张末期压力、E/A、超声心动图测得的左心室每搏量指数与BNP之间的关系。

结果

39例患者显示冠状动脉狭窄≥75%（CS），6例患者存在慢性完全闭塞。在CS（+）组中，BNP和左心室舒张末期压力显著升高（50.7±48.5对22.1±21.6 pg/ml，p<0.05；9.2±5.3对6.4±3.4 mmHg，p<0.05）。在逻辑回归分析中，BNP和左心室舒张末期压力与CS（+）有显著相关性，独立于年龄、收缩压、E/A和左心室射血分数（分别为p=0.007，p=0.05）。BNP（>20 pg/ml）对CS（+）诊断的预后价值为敏感性79%，特异性61%（p<0.005）。在CS（-）组中，BNP>20 pg/ml的患者比BNP≤20 pg/ml的患者年龄更大（68.4±8.5对60.0±9.4，p<0.05）。因此，在较年轻组（年龄<65岁，n=42）中，预后价值降低（敏感性78%，特异性82%，p<0.005）。即使在有冠状动脉狭窄但无慢性完全闭塞的患者中，与无冠状动脉狭窄的患者相比，BNP和左心室舒张末期压力均显著升高（22.1±21.6对44.0±43.2 pg/ml，p<0.01；6.4±3.4对9.1±5.2 mmHg，p<0.01）。