血浆NT-proBNP水平对冠心病患者病变严重程度的预测价值和经皮冠状动脉介入治疗临床莸益的评价
[Abstract]:AIM: Acute and chronic myocardial ischemia and hypoxia in coronary heart disease (CHD) leads to pathological remodeling, abnormal wall tension, and high BNP levels characterized by wall dyskinesia, leading to major adverse cardiovascular events. Many clinical studies have shown that plasma BNP/NT-proBNP levels are closely related to the severity of coronary heart disease. In this study, we analyzed the relationship between the severity of coronary artery disease, wall dyskinesia, myocardial infarction and PCI treatment history and plasma NT-proBNP levels in patients with acute myocardial infarction. Methods: A total of 1225 patients with coronary artery disease who underwent coronary angiography in the Department of Cardiovascular Internal Medicine of the First Clinical Medical College of Nanjing Medical University were enrolled in this study. The severity of coronary artery lesions was assessed by the SYNTAX scoring system. The severity of coronary artery lesions was analyzed by multivariate logistic regression analysis (referring to SYNTAX score), PCI history of old myocardial infarction, acute myocardial infarction, and resting ventricular wall dyskinesia, gender, age, TG/HDL-c, hs-CR. To explore the predictive value of plasma NT-proBNP level on clinical prognosis of patients with coronary heart disease (CHD). Results: There was a significant positive correlation between severity of coronary artery disease and plasma NT-proBNP level, ORSCAD = 2.383, P = 0.011. Plasma NT-proBNP level in patients with myocardial infarction was significantly higher than that in patients with old myocardial infarction (ORO). MI = 2.836, P = 0.007; acute myocardial infarction ORAMI = 4.501, P 0.001. Two-dimensional echocardiography showed a strong positive correlation between ventricular wall dyskinesia and plasma NT-proBNP levels, and stratified analysis of VWD (0, 1, 2) showed that OR1 = 3.309, P = 0.002, OR2 = 14.366, P 0.001. The severity of coronary artery disease, resting wall dyskinesia, old myocardial infarction, acute myocardial infarction and previous PCI operation history are closely related. The level of plasma NT-proBNP can reflect the severity of coronary artery disease. Persistent high plasma levels of NT-proBNP (BNP) in patients with coronary heart disease suggest worsening cardiac function and poor clinical prognosis. OBJECTIVE: Plasma BNP levels in patients with coronary heart disease are sensitive to the extent and severity of myocardial ischemia in patients with severe coronary artery disease, and high BNP levels in water. Early revascularization of acute myocardial infarction (including ST-segment elevation and non-ST-segment elevation) can reduce myocardial necrosis and improve prognosis. Studies have found that BNP/NT-proBNP detection in hospitalized ACS patients. We attempted to retrospectively study whether PCI treatment could bring clinical benefits to patients with coronary heart disease and myocardial infarction, including relatively stable coronary heart disease. Methods: Nanjing Medical University was selected to conduct a preliminary evaluation. A total of 1225 patients with coronary artery disease underwent coronary angiography in the Department of Cardiovascular Internal Medicine of the First Clinical Medical College were enrolled in this study. Correlation between factors such as myocardial infarction, acute myocardial infarction, wall dyskinesia, PCI operation history, gender, age, LDL-c, TG/HDL-c, hs-CRP, blood glucose and plasma NT-proBNP was studied. The clinical value of PCI in patients with coronary heart disease, including relatively stable and myocardial infarction, was evaluated preliminarily. Plasma NT-proBNP levels in patients with myocardial infarction (OR = 0.159, P = 0.003); PCI therapy decreased plasma NT-proBNP levels in patients with severe coronary artery disease (severe two-vessel disease and three-vessel disease) including myocardial infarction (OR = 0.308, P = 0.003); however, PCI therapy did not even reduce plasma NT-proBNP levels in patients with mild coronary artery disease, including myocardial infarction (MI). Plasma NT-proBNP levels (OR = 1.101, P = 0.913); PCI treatment for relatively stable patients with coronary heart disease plasma NT-proBNP levels are not statistically significant (OR = 0.504, P = 0.141). Conclusion: Our retrospective clinical study preliminarily shows that the severity of coronary artery disease in patients with coronary heart disease, PCI treatment brings patients with more serious. The clinical value of lowering plasma NT-proBNP level is more significant. PCI is the most valuable therapy for patients with myocardial infarction, and the lowering of plasma BNP level is also the most significant. PCI treatment for patients with mild coronary artery disease identified by coronary angiography may not bring clinical benefits, or even harmful. We should pay attention to the urgency. The results of this study do not support a completely revascularized PCI regimen for relatively stable patients with coronary artery disease. For mild coronary artery disease Variable stent implantation should be considered carefully and PCI guided by flow reserve fraction (FFR) is recommended for critical coronary lesions to effectively avoid unnecessary stent implantation.
【学位授予单位】:南京医科大学
【学位级别】:博士
【学位授予年份】:2016
【分类号】:R541.4
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