血清BNP和Hcy水平预测冠脉旁路移植术疗效及预后的价值  

Predictive value of serum BNP and Hcy levels for therapeutic effect and prognosis of coronary artery bypass grafting

作　　者：冯涛[1] 王宗社[1] 舒端朝[1] 王小军[1] 张顺军 赵龙[1] FENG Tao;WANG Zong-she;SHU Duan-zhao;WANG Xiao-jun;ZHANG Shun-jun;ZHAO Long(Department of Cardiovascular Surgery,Central Hospital of Baoji City,Baoji,Shaanxi,721008,China)

机构地区：[1]宝鸡市中心医院心血管外科

出　　处：《心血管康复医学杂志》2019年第4期401-405,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:分析评价冠脉旁路移植术(CABG)患者术前血清脑钠肽(BNP)和同型半胱氨酸(Hcy)水平变化预测CABG疗效与预后的价值。方法:收集115例在本院行CABG患者的临床资料,比较不同病变程度、疗效、预后患者术前血清BNP、Hcy水平差异,分析血清BNP、Hcy水平对手术疗效以及预后的影响。结果:与中度、轻度病变组比较,重度病变组术前血清BNP[(151.86±22.57) pg/L比(82.57±10.26) pg/L比(283.51±32.47) pg/L]和Hcy[(18.37±4.51)μmol/L比(12.74±2.04)μmol/L比(31.56±5.17)μmol/L]水平显著升高,且中度病变组显著高于轻度病变组( P 均=0.001);与有效、无效组比较,显效组患者术前血清BNP[(227.49±24.52)pg/L比(308.26±34.12)pg/L比(90.13±10.75)pg/L]、Hcy [(29.12±5.83)μmol/L 比(46.15±7.49)μmol/L比(19.03±3.77)μmol/L]水平显著降低,且有效组显著低于无效组( P 均=0.001);与桥血管狭窄、桥血管畅通组比较,死亡组患者术前血清BNP[(271.47±25.18)pg/L比(92.41±11.06)pg/L比(312.54±35.06)pg/L]、Hcy[(33.08±6.14)μmol/L比(20.05±3.68)μmol/L比(50.21±7.75)μmol/L]水平显著升高,且桥血管狭窄组显著高于桥血管通畅组( P 均=0.001)。Spearman相关性分析显示,BNP、Hcy与冠心病严重程度、CABG术后预后呈显著正相关( r =0.624~0.814, P <0.05或<0.01)。多元Logistic回归分析显示,BNP、Hcy是冠心病患者CABG术后预后的独立危险因素(OR=5.133、1.803, P 均=0.001)。结论:冠脉旁路移植术患者术前BNP和Hcy水平越高,疗效越差,发生血管狭窄及死亡预后的风险也越高。Objective: To analyze and evaluate predictive value of preoperative changes of serum levels of brain natriuretic peptide (BNP) and homocysteine (Hcy) levels for therapeutic effect and prognosis of coronary artery bypass grafting (CABG) in patients undergoing CABG. Methods: Clinical data of 115 patients undergoing CABG in our hospital were collected. Preoperative serum levels of BNP and Hcy were compared among patients with different disease severity,therapeutic effect and prognosis. Influence of serum BNP and Hcy levels on therapeutic effect and prognosis of CABG were analyzed. Results: Compared with medium and mild disease group,there were significant rise in preoperative serum levels of BNP[(151.86±22.57) pg/L vs.(82.57±10.26) pg/L vs.(283.51±32.47) pg/L] and Hcy[(18.37±4.51)μmol/L vs.(12.74±2.04)μmol/L vs.(31.56±5.17)μmol/L] in severe disease group,and those of medium disease group were significantly higher than those of mild disease group, P =0.001 all;compared with effective group and ineffective group,there were significant reductions in preoperative serum levels of BNP[(227.49±24.52)pg/L vs.(308.26±34.12)pg/L vs.(90.13±10.75)pg/L] and Hcy [(29.12±5.83)μmol/L vs.(46.15±7.49)μmol/L vs.(19.03±3.77)μmol/L] in markedly effective group,and those of effective group were significantly lower than those of ineffective group, P =0.001 all. Compared with stenotic graft group and smooth graft group,there were significant rise in preoperative serum levels of BNP [(271.47±25.18)pg/L vs.(92.41±11.06)pg/L vs.(312.54±35.06)pg/L] and Hcy[(33.08±6.14)μmol/L vs.(20.05±3.68)μmol/L vs.(50.21±7.75)μmol/L] in death group,and those of stenotic graft group were significantly higher than those of smooth graft group, P =0.001 all. Spearman correlation analysis indicated that serum BNP and Hcy levels were significant positively correlated with severity of CHD and prognosis of CABG ( r =0.624~0.814, P <0.05 or <0.01). Multifactor Logistic regression analysis indicated that serum BNP and Hcy levels were indepen

关 键 词：冠心病 利钠肽 脑 高半胱氨酸 

分 类 号：R541.409[医药卫生—心血管疾病]