CAJ | 학술논문

背景：B型脑钠肽已成为心血管疾病诊断重要的血清标志物，作为心血管疾病危险因素分层的重要因子。目的：分析冠状动脉旁路移植前后B型脑钠肽与各项血流动力学参数的关系。 　　方法：选择30例冠心病行冠脉旁路移植患者，分为左室射血分数≥50%心功能正常患者13例；左室射血分数<50%心功能不全患者17例。观察患者移植前1 d、移植后7 h、移植后1，3，5，7 d血浆B型脑钠肽水平变化趋势，分析移植前后B型脑钠肽与心功能各项指标的相关关系。 　　结果与结论：左室射血分数≥50%组患者冠脉旁路移植前后血浆B型脑钠肽水平显著低于左室射血分数<50%组；组内比较移植后血浆B型脑钠肽水平均显著高于移植前(P <0.05或P<0.001)。患者冠脉旁路移植前B型脑钠肽水平与纽约心脏病协会心功能分级、左房内径、左室内径呈正相关(r=0.61；r=0．34；r=0．67)；与左室射血分数、心排血量呈负相关(r=-0.75；r=-0.70)。患者移植后B型脑钠肽峰值浓度与出院前纽约心脏病协会心功能分级、超声心动图左室舒张末期内径、肺动脉压力呈正相关(r=0.72；r=0.70；r=0.45)。结果说明冠心病患者冠脉旁路移植前血浆B型脑钠肽质量浓度与左心室射血分数及左心室舒张末期内径有很好的相关性，能准确反映冠脉旁路移植前后的心功能状态。
배경：B형뇌납태이성위심혈관질병진단중요적혈청표지물，작위심혈관질병위험인소분층적중요인자。목적：분석관상동맥방로이식전후B형뇌납태여각항혈류동역학삼수적관계。 　　방법：선택30례관심병행관맥방로이식환자，분위좌실사혈분수≥50%심공능정상환자13례；좌실사혈분수<50%심공능불전환자17례。관찰환자이식전1 d、이식후7 h、이식후1，3，5，7 d혈장B형뇌납태수평변화추세，분석이식전후B형뇌납태여심공능각항지표적상관관계。 　　결과여결론：좌실사혈분수≥50%조환자관맥방로이식전후혈장B형뇌납태수평현저저우좌실사혈분수<50%조；조내비교이식후혈장B형뇌납태수평균현저고우이식전(P <0.05혹P<0.001)。환자관맥방로이식전B형뇌납태수평여뉴약심장병협회심공능분급、좌방내경、좌실내경정정상관(r=0.61；r=0．34；r=0．67)；여좌실사혈분수、심배혈량정부상관(r=-0.75；r=-0.70)。환자이식후B형뇌납태봉치농도여출원전뉴약심장병협회심공능분급、초성심동도좌실서장말기내경、폐동맥압력정정상관(r=0.72；r=0.70；r=0.45)。결과설명관심병환자관맥방로이식전혈장B형뇌납태질량농도여좌심실사혈분수급좌심실서장말기내경유흔호적상관성，능준학반영관맥방로이식전후적심공능상태。
BACKGROUND:Brain natriuretic peptide, an important serum marker for diagnosis of cardiovascular diseases, is crucial for risk factor analysis of cardiovascular diseases. OBJECTIVE: To analyze the relationship between brain natriuretic peptide and hemodynamic parameters before and after coronary artery bypass grafting. METHODS:Thirty patients with coronary heart disease undergoing coronary artery bypass grafting were selected, including 13 patients with left ventricular ejection fraction≥ 50% (normal heart function) and 17 patients with left ventricular ejection fraction < 50% (cardiac insufficiency). Levels of plasma brain natriuretic peptides were detected at 1 day before transplantation, 7 hours, 1, 3, 5, 7 days after transplantation, and then the correlation between plasma brain natriuretic peptide levels and hemodynamic parameters was analyzed before and after coronary artery bypass grafting. RESULTS AND CONCLUSION: Preoperative and postoperative levels of plasma brain natriuretic peptides were significantly lower in the patients with left ventricular ejection fraction≥ 50% than those with left ventricular ejection fraction < 50%; while in each group, the level of brain natriuretic peptides was remarkably increased after coronary artery bypass grafting (P < 0.05 orP< 0.001). Preoperative brain natriuretic peptide levels were positively correlated with New York Heart Association classification grading, left atrial diameter and left ventricular diameter (r=0.61;r=0.34;r=0.67), but negatively correlated with echocardiographic left ventricular ejection fraction and cardiac output (r=-0.75;r=-0.70). The postoperative peak level of brain natriuretic peptides was positively correlated with New York Heart Association classification grading, echocardiographic left ventricular end diastolic diameter and pulmonary artery pressure (r=0.72;r=0.70;r=0.45). These findings indicate that the plasma level of brain natriuretic peptides before coronary artery bypass grafting shows a good correlation with left ventricular ejection fraction and left ventricular end diastolic diameter, which accurately reflect the state of cardiac function before coronary artery bypass grafting.