| Background and Significance B-type natriuretic peptide(BNP) is a 32-amino-acid polypeptide secreted by the cardiac ventricles in response to ventricular volume expansion and pressure overload. Originally isolated from pig brain, so people usually call it brain natriuretic peptide too. On secretion, pro-BNP(the storage of BNP) is cleaved into the inactive N-terminal pro-BNP and an endocrinologically active BNP. BNP has been shown to aid in the diagnosis of heart failure and to correlate with function status among patients with chronic heart failure (CHF). Now BNP Measurement is selected as a objective marker in the diagnosis, prognosis and treatment of heart failure in America and Europe, especially recommended by American cardiac college and America heart association( ACC/AHA) Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult(2001).However recent studies have also demonstrated a strong association between elevated plasma BNP levels and an increased incidence of adverse outcomes in patients with acute coronary syndrome(ACS). The data suggest that levels of BNP not only correlate with left ventricular dilatation, remodeling,and dysfunction; but also with acute myocardial ischemia. To examine the plasma BNP level of ACS patientis a hot-point study now. While published studies had diferent opinions, few studies abroad or internal were involved in clinical changes of the plasma BNP levels in ACS patients.Objective⑴To explore the diversity of plasma levels of B-type natriuretic peptide(BNP) and fibrinogen(FIB) in patients with coronary heart disease(CHD) and with different degrees of coronary artery lesions.⑵To investigate the correlation of the plasma BNP and FIB levels with major adverse cardiovascular events(MACE) during hospitalization.Method 110 patients with CHD were enrolled in this study, including 45 patients in acute myocardial infarction(AMI) group,39 patients in unstable angina pectoris(UAP) group, 26 patients in stable angina pectoris(SAP) group; 50 persons without CHD as control group. Plasma levels of BNP were detected at 16 to 20 hours after the appearance of symptoms in AMI or on admission in other groups. At the same time, plasma levels of FIB were measured .Comparing the difference of BNP levels or FIB levels among groups.Result⑴The level of BNP was significantly higher in AMI than in other three groups(P<0.01); the level of BNP was significantly higher in UAP than in SAP or control(P<0.01); the level of BNP was higher in SAP than in control(P<0.05). The level of BNP was significantly higher in patients who had complex lesions compared with those who had simple or no lesions (P<0.01);⑵The level of FIB was significantly higher in AMI than in other three groups(P<0.01); the level of FIB was significantly higher in UAP compared with control(P<0.05), there were no difference in FIB level between SAP and control(P>0.05). The level of FIB was significantly higher in patients who had complex lesions compared with those who had simple or no lesions(P<0.01);⑶The result showed that there were higher plasma BNP and FIB levels of the MACE patients than that of the ACS patients without MACE(P<0.05).Conclusion⑴Plasma levels of BNP and FIB are associated with clinical phenotypes of CHD and elevated levels are significantly associated with more complex lesions.⑵Assay for plasma BNP and FIB levels of the patients with ACS can carry helpful important information for acute coronary syndrome risk stratification; and be kept as early warning factor with MACE. |
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