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目的:观察心房压力快速变化对血浆B型钠尿肽(BNP)水平的影响。方法:采用床边快速BNP试验法检测30例成功施行二尖瓣球囊扩张术(PBMV)的风湿性二尖瓣狭窄患者术前、术后20min及术后24h血浆BNP浓度,与正常对照组(8例)比较,并将患者血浆BNP浓度与平均左房压(mLAP)等血流动力学参数作相关分析。结果:术前,二尖瓣狭窄患者血浆BNP水平显著高于正常对照组[(123.55±69.49)ng/L∶(16·39±7·64)ng/L,P<0·01)];且与mLAP呈显著正相关(r=0·441,P<0·05);BNP浓度在心房颤动(房颤)患者与窦性心律患者间差异无统计学意义(P>0·05)。术后,房颤患者血浆BNP浓度无明显改变[术前(111.62±53.41)ng/L,术后20min(122.04±68.70)ng/L,术后24h(106.11±56.19)ng/L,两两比较P>0·05];而窦律患者有显著下降[术前(128.66±75.96)ng/L,术后20min(88.59±61.99)ng/L,术后24h(43.39±26.70)ng/L,两两比较P<0·05)]。窦律患者中,术后20min的BNP变化(ΔBNP)与mLAP变化(ΔmLAP)呈显著正相关(r=0·696,P<0·01);术后24h的BNP变化(ΔBNP’)与二尖瓣口面积(MVA)的扩大值(ΔMVA)及左房内径(LAD)的变化(ΔLAD)无相关性(分别r=0·048,P>0·05;r=-0·070,P>0·05)。结论:二尖瓣狭窄患者血浆BNP水平的升高和左房压升高显著相关。BNP是反映窦律患者球囊扩张术后左房压变化的敏感指标。
Objective: To observe the effect of rapid changes of atrial pressure on the plasma level of natriuretic peptide (BNP). Methods: The fasting BNP test was used to detect plasma BNP levels in 30 patients with rheumatic mitral stenosis who underwent mitral balloon dilatation (PBMV) successfully before operation, 20 min after operation and 24 h after operation. Compared with the normal control group (8 cases). The correlation between plasma BNP concentration and mean left atrial pressure (mLAP) was also analyzed. Results: Plasma BNP levels in patients with mitral stenosis before surgery were significantly higher than those in the control group [(123.55 ± 69.49) ng / L: (16.39 ± 7.74) ng / L, P <0.01] (R = 0.441, P <0.05). There was no significant difference in BNP concentration between patients with atrial fibrillation and sinus rhythm (P> 0.05). After operation, there was no significant change in plasma BNP concentration in patients with AF (111.62 ± 53.41 ng / L, 122.04 ± 68.70 ng / L, 106.11 ± 56.19 ng / L, (P> 0.05). However, patients with sinus rhythm had a significant decrease (128.66 ± 75.96 ng / L before surgery, 88.59 ± 61.99 ng / L after operation and 43.39 ± 26.70 ng / L after operation , P <0.05 compared with each other)]. In patients with sinus rhythm, the change of BNP (ΔBNP) and the change of mLAP (ΔmLAP) at 20 min after operation showed a significant positive correlation (r = 0.696, P <0.01); the change of BNP (ΔBNP ’ No correlation was found between the MVA expansion (ΔMVA) and the change in left atrium LAD (ΔLAD) (r = 0 · 048, P · 0 · 05; r = -0 · 070, P > 0 · 05). CONCLUSIONS: Elevated BNP levels in patients with mitral stenosis were significantly associated with elevated left atrial pressure. BNP reflects the change of left atrial pressure after balloon dilatation in patients with sinus rhythm.