再灌注治疗前后血浆脑钠素的变化及其关系

Plasma N-terminal brain natriuretic peptide following acute myocardial infarction: Relationship with the state of myocardial microcirculatory reperfusion

目的观察急性心肌梗死(AMI)患者急诊介入治疗(PCI)前后脑钠素前体片段(N-BNP)、炎性细胞因子(IL-6、TNFα)的动态变化及其与心肌组织水平灌注状态的关系。方法放免法测定22例AMI患者急诊冠状动脉介入治疗术(PCI)前即刻、术后12小时及24小时血浆N-BNP、IL-6及TNFα的变化,以PCI术后2小时心电图ST段回落大于70%作为心肌组织灌注良好标准。结果①AMI患者血浆N-BNP、IL-6、TNFα水平PCI后12小时均较术前显著增高(均P<0.01),术后24小时回落。②PCI术后12小时及24小时,心肌灌注不良的患者血浆N-BNP、IL-6、TNFα增高更加明显(P<0.01,P<0.05,P<0.05)。结论AMI再灌注过程中血浆N-BNP与炎性细胞因子水平同步增高,其增高水平与心肌组织灌注状态密切相关。

Background Circulating levels of brain natriuretic peptide (BNP), a cardiac hormone reflects the severity of cardiac dysfunction, increase following AMI and decrease following reperfusion, however, relationships among its segment, N-terminal BNP, and the state of myocardial microcirculatory reperfusion and inflammation are still unknown. Methods and Results 22 patients with AMI and 8 healthy volunteers were analyzed. Plasma N-BNP, interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α) were measured in RIA assay before emergency PCI, after 12h and 24h post-intervention. ST-segment reduction>70% in ECG on 2 hours after reperfusion was as the marker of efficient reperfusion. Plasma N-BNP, IL-6 and TNF-α following emergency PCI were all significantly higher than those before PCI( P <0.01, P <0.01 and P <0.01 respectively);simultaneously the differences were less significant when efficient reperfusion was acquired( P <0.01, P <0.05 and P <0.05 respectively).Conclusions Plasma N-BNP correlates with the state of myocardial microcirculatory reperfusion and inflammation.