摘要
目的探讨风湿性心脏病二尖瓣狭窄患者行经皮球囊二尖瓣成形术(PBMV)前后及不同心律时,外周静脉血中心房利钠肽(ANP)和脑钠肽(BNP)变化及与血液动力学参数之间的关系。方法选择成功行PBMV的风湿性二尖瓣狭窄患者36例,其中窦性心律11例,心房颤动25例。于PBMV术前及术后1天、3天取外周静脉血,分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值;用心导管测定左房平均压(LAP)、肺动脉压(PAP);术后1天行超声心动图测左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MPG)。结果PBMV术后ANP逐渐下降,由术前216.09±73.84pg/mL降至术后1天188.70±59.22pg/mL,术后3天140.70±41.53pg/mL(P<0.05),其中窦性心律组比心房颤动组ANP下降明显(64.09±32.89pg/mL比32.93±25.73pg/mL,P<0.05)。术后,窦性心律组中BNP先升高、后降低,由术前545.50±206.20pg/mL升至术后1天662.00±270.16pg/mL,术后3天降至430.05±206.30pg/mL(P<0.05);而心房颤动组BNP变化差异无统计学意义。术后1天与术前比较,ANP降低(ΔANP)与LAP下降相关性最好(r=0.565,P<0.01),BNP的差值(ΔBNP)与MPG的差值(ΔMPG)呈负相关(r=-0.474,P<0.05),而ΔANP/ΔBNP与MPG下降负相关(r=-0.556,P<0.05)。结论PBMV术后,窦性心律患者比心房颤动患者血浆中ANP、BNP下降明显。PBMV术能有效改善患者的血液动力学。ΔANP/ΔBNP比值是反应MPG变化的有效指标。
Objective To observe the changes of atrial natriuretic peptide （ANP） and brain natriuretic peptide （BNP） in plasma and the correlation of ANP and BNP with hemodynamic parameters in patients with sinus rhythm or atrial fibrillation after percutanous balloon mitral valvuloplasty （ PBMV）, Methods Thirty-six patients with rheumatic mitral stenosis undergoing first time successful PBMV were enrolled in the study. Among a total of 36 patients, 11 were in sinus rhythm （SR group） and 25 had atrial fibrillation （ Af group）. The levels of ANP and BNP were assayed before and at 1 day and 3 days after the procedure. Hemodynamic parameters were measured by echocardiography and left atrial pressure （LAP） and pulmonary artery pressure （PAP） were assessed instantly by cardiac catheter before and after PBMV. Results After PBMV, the ANP levels gradually decreased （216,09±73.84 pg/mL; 188.70±59.22 pg/mL; 140. 70±41.53 pg/mL, respectively, before, at one day and three days after procedure, P 〈 0. 05） and the levels reduced more significantly in the SR group than in the Af group （64.09±32. 89 pg/mL vs 32. 93±25.73 pg/mL,P 〈0. 05）. In the SR group, BNP levels rose at first and then declined （545.50±206. 20 pg/mL; 662.00±270. 16 pg/mL; 430. 05±206. 30 pg/mL,P 〈0. 05）. However, in the Af group the BNP remained unchanged after PBMV. Compared the data at I-day after PBMV with that before the procedure PBMV, the changes of plasma ANP（AANP） were correlated with the changes of LAP（ r = 0. 565;P 〈 0.01 ）. The relation between changes in plasma BNP （ABNP） and mitral pressure gradient （AMPG） was negative （r = -0. 474; P 〈0. 05）. At the same time the ratio of changes of ANP and BNP （AANP/ABNP） was negatively correlated with changes of MPG （AMPG） （ r = - 0. 556 ; P 〈 0.05 ）. Conclusion The levels of plasma ANP and BNP decrease more significantly in the SR group than in the Af group. The hemodynamic environment changes remarkedly in patients after PBMV, and
出处
《中国介入心脏病学杂志》
2007年第5期262-265,共4页
Chinese Journal of Interventional Cardiology
关键词
二尖瓣狭窄
心脏导管插入术
心钠素
利钠肽
脑
血液动力学现象
Mitral valve stenosis
Heart catheteriration
Atrial natriuretic factor
Natriureticpeptide, brain
Hemodynamics phenomena
