Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Korean Circ J. 2013 Mar;43(3):168-73. doi: 10.4070/kcj.2013.43.3.168. Epub 2013 Mar 31.
The purpose of this study was to assess the value of C-type natriuretic peptide (CNP) as a surrogate marker for detection of coronary artery spasm in variant angina pectoris (VAP).
Sixty-six patients (mean age: 51±11 years, M : F=40 : 26) who underwent coronary angiography on suspicion of angina and who were diagnosed with VAP by the acetylcholine-induced spasm provocation test (SPT) were enrolled and divided into a SPT (-) group (n=23) and a SPT (+) group (n=43). Concentrations of CNP and other markers were determined by immunoassay in both groups.
Plasma CNP and creatine kinase myoglobin band (CK-MB) concentrations were significantly increased in the SPT (+) group relative to the SPT (-) group (CNP, 5.268±1.800 pg/mL vs. 3.342±1.150 pg/mL, p=0.002; CK-MB, 2.54±1.03 ng/dL vs. 1.86±0.96 ng/dL, p=0.019, respectively) while plasma high sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT pro-BNP) concentrations were not significantly different between the SPT (-) group and SPT (+) group (hs-CRP, 2.76±4.99 mg/L vs. 3.13±4.88 mg/L, p=0.789; NT pro-BNP, 49±47 pg/mL vs. 57±63 pg/mL, p=0.818, respectively). Plasma CNP concentration was independently associated with the VAP via SPT {odds ratio: 2.014 (95% confidence interval: 1.016-3.992), p=0.045}. A CNP cut-off value of 4.096 pg/mL was found to have a sensitivity of 68.2% and a specificity of 40.0% for predicting the probability of VAP via SPT.
Increased plasma CNP concentration in patients with VAP may have an impact on the regulation of endothelial function in accordance with the progression of atherosclerosis. Further analysis is warranted to develop clinical applications of this finding.
本研究旨在评估 C 型利钠肽（CNP）作为变异性心绞痛（VAP）患者冠状动脉痉挛检测替代标志物的价值。
共纳入 66 例因怀疑心绞痛而行冠状动脉造影且乙酰胆碱诱导痉挛激发试验（SPT）诊断为 VAP 的患者（平均年龄 51±11 岁，男：女=40：26），并将其分为 SPT（-）组（n=23）和 SPT（+）组（n=43）。采用免疫分析法测定两组患者 CNP 和其他标志物的浓度。
与 SPT（-）组相比，SPT（+）组患者的血浆 CNP 和肌红蛋白带肌酸激酶（CK-MB）浓度显著升高（CNP，5.268±1.800 pg/mL 比 3.342±1.150 pg/mL，p=0.002；CK-MB，2.54±1.03 ng/dL 比 1.86±0.96 ng/dL，p=0.019），而 SPT（-）组和 SPT（+）组患者的血浆高敏 C 反应蛋白（hs-CRP）和氨基末端脑钠肽前体（NT pro-BNP）浓度无显著差异（hs-CRP，2.76±4.99 mg/L 比 3.13±4.88 mg/L，p=0.789；NT pro-BNP，49±47 pg/mL 比 57±63 pg/mL，p=0.818）。通过 SPT，血浆 CNP 浓度与 VAP 独立相关[比值比：2.014（95%置信区间：1.016-3.992），p=0.045]。发现 CNP 截断值为 4.096 pg/mL 时，预测 SPT 诊断 VAP 的概率，其灵敏度为 68.2%，特异性为 40.0%。
VAP 患者血浆 CNP 浓度升高可能与动脉粥样硬化进展相关的内皮功能调节有关。需要进一步分析以开发该发现的临床应用。
