风湿性心脏病瓣膜置换术患者围术期血浆脑钠肽水平的表达及临床意义

目的:探讨风湿性心脏病瓣膜置换术患者围手术期血浆脑钠肽(BNP)水平及其临床意义。方法:选取2015年1月至2016年12月在我院接受心脏瓣膜置换术的风湿性心脏病患者98例为研究对象,分别于术前、术后12 h、24 h、48 h、术后1周进行血浆BNP、磷酸肌酸同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)水平检测,观察纽约心脏病协会(NYHA)不同心功能分级、不同时间点患者血浆BNP、CK-MB、hs-CRP水平变化,同时观察并比较术后发生严重心律失常与否的患者在不同时间点血浆BNP、CK-MB、hs-CRP水平变化。结果:随NYHA心功能分级升高,患者血浆BNP、CK-MB、hs-CRP水平升高,不同NYHA心功能分级患者血浆BNP、hs-CRP水平比较差异有统计学意义(P0.05),CK-MB水平比较差异无统计学意义(P0.05);不同NYHA心功能分级患者血浆BNP、hs-CRP两两比较差异有统计学意义(P0.05),CK-MB两两比较差异无统计学意义(P0.05)。患者术后12 h、24 h、48 h血浆BNP、hs-CRP水平均显著高于术前,术后24 h、48 h血浆CK-MB水平均显著高于术前,而术后1周血浆BNP、CK-MB、hs-CRP显著低于术前(P0.05)。术后发生严重心律失常(严重心律失常组)患者16例,未发生严重心律失常(无严重心律失常组)患者82例,两组患者术后12 h、24 h、48 h血浆BNP、CK-MB、hs-CRP水平均显著高于术前(P0.05);两组患者术后1周BNP与术前比较差异无统计学意义(P0.05),而CK-MB、hs-CRP水平均显著低于术前(P0.05),但严重心律失常组术后12 h、24h、48 h、1周血浆BNP、CK-MB、hs-CRP水平均显著高于无严重心律失常组(P0.05)。结论:风湿性心脏病瓣膜置换术患者术前血浆BNP可以反映患者心功能情况,术后患者血浆BNP、CK-MB、hs-CRP异常升高,发生严重心律失常患者升高更为明显。

Expression of Plasma Brain Natriuretic Peptide in Patients with Rheumatic Heart Disease Undergoing Valve Replacement and its Clinical Significance

ABSTRACT Objective: To investigate the level of plasma brain natriuretic peptide (BNP) in patients with rheumatic heart disease undergoing valve replacement and its clinical significance. Methods: 98 patients with rheumatic heart disease who were underwent valve replacement in our hospital from January 2015 to December 2016 were selected as the subjects, the levels of plasma BNP, creatine phos- phate isoenzyme (CK-MB) and high sensitive C reactive protein (hs-CRP) were detected before operation and 12 h, 24 h, 48 h and 1 weeks after operation respectively, the changes of plasma BNP, CK-MB and hs-CRP levels in patients with different cardiac function classification of New York Heart Association (NYHA) and different time points, at the same time, the changes of plasma BNP, CK-MB and hs-CRP levels were observed and compared at different time points in patients with Severe arrhythmia or not. Results: With the in- crease of NYHA cardiac function classification, the plasma BNP, CK-MB and hs-CRP levels increased, and there were significant differ- ences in the plasma BNP and hs-CRP levels between different NYHA cardiac function classification (P<0.05), there was no significant difference in CK-MB level between different NYHA cardiac function classification (P>0.05). There were significant differences in plasma BNP and hs-CRP between patients with different NYHA cardiac function classification (P<0.05), there was no significant difference in CK-MB (P>0.05). The plasma BNP and hs-CRP levels in patients with 12 h, 24 h and 48 h after operation were significantly higher than those before operation, the CK-MB levels in 24 h and 48 h after operation were significantly higher than those before operation, the plasma BNP, CK-MB and hs-CRP at 1 weeks after operation were significantly lower than those before operation (P<0.05). There were 16 pa- tients with severe arrhythmia (severe arrhythmia group) after operation, there were 82 patients without severe arrhythmia (no severe ar- rhythmia group), the plasma BNP, CK-MB and hs-CRP levels in the two groups at 12 h, 24 h and 48 h after operation were significantly higher than those before operation (P<0.05). There was no significant difference in BNP of the two groups between 1 weeks after opera- tion and before operation (P>0.05), the CK-MB and hs-CRP levels were significantly lower than those before operation (P<0.05), however, the plasma BNP, CK-MB and hs-CRP levels in the severe arrhythmia group 12 h, 24 h, 48 h and 1 weeks after operation were significantly higher than those no severe arrhythmia (P<0.05). Conclusion: Preoperative plasma BNP can reflect the cardiac function in patients with rheumatic heart disease undergoing valve replacement, the plasma BNP, CK-MB and hs-CRP levels were abnormally elevated after oper- ation, the increase of the patients with severe arrhythmia is more obvious.