急性心肌梗死患者血浆心钠素与心肌肌酸激酶测定

Measurement of the plasma ANP and serum CK-MB in patients with acute myocardial infarction

目的 :探讨急性心肌梗死 (AMI)患者血浆心钠素 (ANP)和血清心肌肌酸激酶 (CK MB)水平的变化及两者的变化与心功能改变的关系。方法 :将胸痛发作后 1h以内的 5 4例AMI患者分为 3组 :未溶栓或溶栓未再通组 (Ⅰa组 ,n =1 3)、溶栓再通组 (Ⅰb组 ,n =2 5 )和合并心功能不全组 (Ⅱ组 ,n =1 6 ,未进行溶栓治疗 ) ,分别测定血浆ANP和CK MB浓度。结果 :5 4例AMI患者血浆ANP和血清CK MB在心肌梗死发生后均升高 ,ANP在症状发作后 1h内急剧升高 ,1 2h以内迅速下降 ,与逐渐升高的血清CK MB呈负相关 (r =- 0 .6 2 ,P <0 .0 1 ) ;1 2h后又开始上升 ,4 8h后两者均下降 ,呈正相关 (r =0 .4 8,P <0 .0 5 )。Ⅰa组和Ⅰb组比较 ,ANP和CK MB差异无统计学意义 (P >0 .0 5 ) ;Ⅰa组和Ⅰb组各个时点的ANP和CK MB均显著低于Ⅱ组 (P <0 .0 0 1 )。结论 :ANP的第一次升高是由于心肌梗死后心功能障碍导致心房内ANP分泌颗粒的释放 ,较CK MB早而迅速 ,第二次升高是心房和心室肌细胞对ANP再合成和释放加速所致 ,对心功能的判断和临床用药具有指导意义。

Aim: To investigate the changes of the plasma ANP and serum CK MB in patients with acute myocardial infarction and the relationship between the changes of the both and the heart dysfunction. Methods: Synchronized plasma ANP and serum CK MB were measured in 54 patients with acute myocardial infarction at 1, 6, 12, 18, 24, 48,and 72 hours after occurance. The patients were divided into three groups: Group Ia, the patients without thrombolytic therapy or without reperfusion through thrombolytic therapy;Group Ib, reperfusion;Group II, companied with heart dysfunction and without thrombolytic therapy. Results: The concentrations of ANP and CK MB increased, and the raising of ANP had two peaks. The first peak appeared within 1 hour after the occurance of symptoms then dropped swiptly. Within 12 hours, it expressed a negative correlation ( r = 0.62, P <0.01) compared with the increasing degree of CK MB. After 12 hours, the degree of ANP increased again and formed the second peak. After 48 hours, both the concentrations of ANP and CK MB decreased and formed a positive correlation( r =0.48, P <0.05). The concentrations of ANP and CK MB in Group Ia was not significant compared with Group Ib. And the concentrations of both in Group Ib were lower than those of Group Ⅱ any times ( P <0.001). Conclusions: The first raising level of ANP is mainly the releasing of secreting granules in atria due to heart dysfunction and is earlier than that of CK MB. The second raising level of ANP is mainly the synthesis and releasing of ANP in atrial and ventricular cells due to myocardial necrosis. Both the concentrations of ANP and CK MB may be used to judge the heart dysfunction and guide to drug choice. Thrombolytic therapy has no any effect on decreasing the concentration of ANP.