二尖瓣球囊扩张术对患者血浆B型利钠肽水平的影响  

Effects of Percutaneous Balloon Mitral Valvuloplasty on Plasma B-type Natriuretic Peptide in Rheumatic Mitral Stenosis Patients

作　　者：来蕾[1] 陈君柱[2] 尚云鹏[2] 王兴祥[2] 张芙荣[2] 

机构地区：[1]杭州市第一人民医院心血管内科,浙江省310006 [2]浙江大学附属第一医院心血管内科

出　　处：《中国循环杂志》2007年第1期48-51,共4页Chinese Circulation Journal

摘　　要：目的:观察二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄患者血浆B型利钠肽(BNP)水平的影响。方法:检测30例成功施行PBMV的二尖瓣狭窄患者(窦性心律21例,心房颤动9例)术前、术后20 min及术后24 h的血浆BNP浓度,与8例对照者比较,并将BNP浓度与血流动力学参数作相关分析。结果:术前30例二尖瓣狭窄患者血浆BNP水平显著高于对照者(P<0．01);且与平均左心房压(r=0．441,P< 0．05)和肺动脉压(r=0．488,P<0．01)呈正相关。心房颤动患者与窦性心律患者BNP浓度无明显差异。术后20 mim及术后24 h窦性心律患者BNP浓度较术前显著下降(P均<0．05),术后24 h左心室舒张末容量(P<0．01)和每搏输出量(P<0．05)较术前相应增加,左心室舒张末压不变;术后20 min的BNP浓度变化与平均左心房压变化(r=0．696,P <0．01)及肺动脉压变化(r=0．456,P<0．05)呈正相关。术后心房颤动患者BNP浓度较术前无明显改变,左心室舒张末容量和每搏输出量相应不变,左心室舒张末压术后20 min较术前增加(P<0．01)。结论:二尖瓣狭窄患者血浆BNP浓度升高和左心房压及肺动脉压升高相关。心脏节律对球囊扩张术后血浆BNP的变化起重要作用,BNP是反映窦性心律患者球囊扩张术后左心房压及肺动脉压变化的敏感指标,但这一指标不适用于心房颤动患者。Objective ： To evaluate the effect of percutaneous balloon mitral valvuloplasty （PBMV） on plasma B-type natriuretic peptide （BNP） levels in rheumatic mitral stenosis patients. Methods： Thirty patients with rheumatic mitral stenosis （21 with sinus rhythm and 9 with atrial fibrillation） successfully undergoing PBMV were included in this study, Plasma BNP concentrations were measured in all patients before, at 20 minutes and 24 hours after PBMV, and compared with 8 healthy volunteers. The relations between BNP concentrations and hemodynamic parameters were studied. Results ： Basal plasma BNP levels in patients were significantly higher than those in the control group （P 〈 0. 01 ）, and they were positively correlated with mean left atrial pressure （ r = 0. 441, P 〈 0. 05 ） and pulmonary artery pressure （ r = 0. 488, P 〈 0. 01 ）. No difference was observed in BNP levels between patients with sinus rhythm and those with atrial fibrillation （ P 〉 0. 05）. In sinus rhythm patients, BNP levels were decreased after PBMV （respectively, P 〈 0. 05）. Plasma BNP levels were positively correlated with those of mean left atrial pressure （r = 0. 696 ,P 〈 0. 01 ） and pulmonary artery pressure （r = 0. 456 ,P 〈 0. 05）. Left ventricular end-diastolic volume （P 〈0. 01 ） and stroke volumes （P 〈0. 05） were increased, but not accompanied by an increase of left ventricular end-diastolic pressure （ P 〉 0. 05）. In atrial fibrillation patients, BNP remained unchanged （ P 〉0. 05）. Left ventricular end-diastolic pressure increased P 〈 0. 01 ） with no changes of left ventricular end-diastolic volume and stroke volumes （ P 〉 0. 05 ）. Conclusions：These results indicate that high BNP level is associated with high left atrial pressure and pulmonary artery pressure in mitral stenosis patients. Cardiac rhythm may play an important role in changes of BNP after PBMV. BNP could be a valid marker to reflect changes in mean left atrial pressure and pulmo

关 键 词：二尖瓣狭窄 经皮二尖瓣球囊扩张术 B型利钠肽 

分 类 号：R654.2[医药卫生—外科学]