| Background and objective:acute coronary syndrome (acute coronary syndrome, ACS) is a group of clinical syndromes, whose pathological basis is coronary atherosclerotic plaque rupture or erosion, secondary to complete or incomplete occlusive thrombosis, including unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI), reflecting the pathophysiological process of acute myocardial ischemia. With the improvement of people's living standard and social activities to accelerate and intensified competition, the incidence of ACS is increasing, and it is the main reason of cardiac death, and the age keeps young. According to datas reported in the United States,1000000 patients hospitalized with ACS each year. Discussion on fast and accurate diagnosis and effective treatment of ACS has been widely attentioned to domestic and foreign medical circles. Brain natriuretic peptide (B-type natriuretic peptide, BNP) as a neuroendocrine hormone, has been approvalled for the serum markers of clinical diagnosis of heart failure, in November 12,2000 by the United States Food and Drug Administration. It is worth noting, a large number of clinical studies show, myocardial ischemia can cause a specific change of BNP level. The quantitative analysis of coronary angiography results is the reliable basis of diagnosis of coronary artery disease and invasive coronary treatment, and the accuracy and the reliability of the results will significantly affect clinical judgment. Then can BNP be one of the biochemical index evaluating in patients with coronary heart disease and the severity of coronary artery disease? this study explores the relationship of BNP levels and coronary severity in patients with percutaneous coronary intervention (PCI), and BNP difference before and after PCI in ACS patients, observation on whether BNP can be the index of observing effect.Methods:(1) the research object:from October 2009 to April 2011,180 cases hospitalized in heart internal medicine and underwent coronary angiography. The patients were divided into 3 groups by angiography results and the clinical diagnosis.140 cases in group ACS, where acute myocardial infarction (STEMI) in 66 cases with ST segment elevation,45 male,21 female, age (60+9); 30 cases non ST segment elevation myocardial infarction (NSTEMI),18 male,12 female, age (60+8); 44 cases unstable angina (UAP),25 male,19 female, age (59+/-9). All cases were diagnosed with the Cardiovascular Branch of Chinese Medical Association of diagnostic criteria.40 cases excluded organic heart disease according to the clinical data and the results of coronary angiography hospitalized at the same time served as control group. Differences about gender and age were not statistically significant (P> 0.05). Exclusion criteria:age> 75 years; chronic obstructive pulmonary disease, severe liver function damage (elevation of transaminases> 3times normal), recent or long-term infection, autoimmune disease, tumor family history and the recent history of the original operation, other diseases that may lead to elevated plasma BNP level, such as renal function insufficiency, hyperthyroidism, primary aldosteronism. (2) research methods:Perform PCI surgery for the ACS patients accord with the diagnosis, and each patient blood 3ml for dtermination of BNP 30 minutes preoperative and 36 hours postoperative. The control group were blooded 2ml for dtermination of BNP 30 minutes before coronary angiography and 36 hours after operation. BNP was determined produces heart failure diagnostic instrument of rapid quantification and Triage BNP stem's bedside rapid detecting plate produced by American BIOSITE company. Method and evaluation of coronary angiography:using the method of Judkins, angiographic results obtained by two experienced cardiac catheterization doctors. determined heart catheter, There are 3 branches, the left anterior descending artery (LAD), the left circumflex branch of left coronary artery (LCX) or right coronary artery (RCA), and stenosis more than 70% of anyone was definited as positive. According to the numbers of the coronary artery branch, the stenosis was classified into 3 groups, single-vessel disease group, double branch and 3 branch lesion group. Left main coronary artery (LCM) lesions, regardless the lesions of the LAD, LCX, are classified as double branch disease group; if combined with RCA lesions,then it is classified as 3 branch lesion group. Normal coronary angiography were included in the control group.Integral method of coronary artery stenosis:according to the Gensini integral method fomulated by American Heart Association (AHA). (3) statistical methods:Using SPSS 17.0 statistical software for statistical analysis. Measurement data were described as (x+s), comparision between the two groups use t test, comparision among many groups use analysis of variance; count data use x2 test; Correlation using linear correlation analysis.The difference was statistically significant if P< 0.05. Result:(1) The BNP levels was elevated in ACS, but the increasing degree was vary, STEMI group was higher than that in NSTEMI group (P< 0.05), and UAP group is higher than that in normal control group (P< 0.05).(2) After PCI, BNP was decreased in ACS, while the control group showed no significant decline.(3) BNP levels increased with the Gensini integral elevation.(4) the correlation analysis showed that, the plasma BNP levels was positively related to the numbers of the coronary branches.Conclusion:(1) The BNP levels elevated in ACS, thus there is a high BNP hyperlipidemia.(2) The plasma level of BNP was corelated to the severity of coronary artery disease, it elevated with the Gensini integral elevation and the increases of the numbers of the stenosis artery.the plasma level of BNP and ACS coronary severity, with the Gensini integral elevation and coronary stenosis count increases in elevation.(3) after PCI, ACS in plasma of patients with BNP were decreased, indicating revascularization greater benefits.(4) ACS patients of high BNP level should be given early intensive treatment and early revascularization.(5) The BNP may be one of the biochemical index of ACS severity. |
