慢性静脉阻塞患者进行静脉再通术和支架植入术后心肌酶和 B 型钠尿肽升高。

Phlebology Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI:10.1177/02683555241261321
Yan Yan, Mohammad E Barbati, Efthymios D Avgerinos, Suat Doganci, Michael Lichtenberg, Houman Jalaie
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引用次数: 0

摘要

背景:B 型钠尿肽(BNP)和心肌酶都是公认的心脏健康生物标志物。许多研究报告称,使用这些指标可以评估心脏状况并预测手术患者的预后。目前,人们对慢性静脉阻塞(CVO)患者静脉再通后增加心脏输入对心脏生理的影响知之甚少:本研究旨在探讨髂腹腔再通术和支架植入术对慢性静脉阻塞(CVO)患者心脏生物标志物的影响:这是一项前瞻性研究,涉及一个单位的 60 名患者。方法:这是一项前瞻性研究,60 名患者在一个科室接受治疗,分别在静脉介入治疗的前一天和后一天进行血液检测。根据心脏生物标志物水平比较了三组患者:第一组:髂股静脉血栓后综合征(PTS)但未累及下腔静脉(IVC)的患者(33 人);第二组:髂股静脉血栓后综合征且累及 IVC 的患者(19 人);第三组:非血栓性静脉病变(NIVL)患者(8 人):结果:术后 BNP 的中位浓度(259.60 pg/mL)高于术前水平(49.80 pg/mL)[四分位距(IQR),147.15/414.68 对 29.85/82.88;P <0.001]。CK-MB水平[术前:3 U/l (IQR, 1.40/11.00) 对术后:14 U/l (IQR, 12/17), p < 0.001]和肌钙蛋白 T [术前:3.00 pg/mL (IQR, 1.40/11.00) 对术后:14 U/l (IQR, 12/17), p < 0.001]:术前:3.00 pg/mL(IQR,3.00/5.25),术后:6 pg/mL(IQR,3.00/9.50),p <0.001]。手术后心肌酶的增加表明,三组的 BNP(p = 0.023)和肌钙蛋白 T(p = 0.007)存在显著差异,而 CK-MB 水平无显著差异(p > 0.05)。术后 BNP 的组间比较:第 1 组对第 2 组(p = 0.013),第 2 组对第 3 组(p = 0.029),第 1 组对第 3 组(p = 0.834);术后肌钙蛋白 T 的组间比较:第 1 组对第 2 组(p = 0.018),第 2 组对第 3 组(p = 0.002),第 1 组对第 3 组(p = 0.282)。根据多元线性回归分析,支架植入时间和术前 BNP 水平是术后 BNP 水平的独立决定因素(p < 0.05),术前肌钙蛋白 T 独立影响术后肌钙蛋白 T(p < 0.05):结论:静脉再通术和支架植入术后肌钙蛋白 T、CK-MB 和 BNP 似乎会升高,病变时间越长,升高越明显。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Elevation of cardiac enzymes and B-type natriuretic peptides following venous recanalization and stenting in chronic venous obstruction.

Background: B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO).

Objectives: The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO.

Methods: This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1 day before and 1 day after venous intervention. Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels.

Results: Median concentration of post-operative BNP (259.60 pg/mL) was greater than preoperative levels (49.80 pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3 U/l (IQR, 1.40/11.00) versus postop: 14 U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00 pg/mL (IQR, 3.00/5.25) versus postop: level of 6 pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05). Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p < 0.05).

Conclusions: Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions.

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