心肌梗死后左心室重构与脑钠素的关系

Relationship between the left ventricular remodeling and brain natriuretic peptide after myocardial infarction

目的:探讨血浆脑钠素水平与急性心肌梗死acutemyocardialinfarction,(AMI)后左室重构的关系,以探讨脑钠素预测心肌梗死预后的可能机制。方法:2003-01/07哈尔滨医科大学第一临床医学院心脏监护病房住院的首次AMI患者185例。选取符合纳入标准的110例为AMI组,男78例,女32例。选择同期本院体检的健康志愿者25例作为对照组,男18例,女7例。所有患者于AMI急性期测定血浆脑钠素浓度,并于取血后24h内以及3个月后行超声心动图检查。根据3个月内左心室容积指标变化将AMI患者分为左心室重构组和非重构组。对比各自的心动超声指标,观察心室重构组与非重构组患者的血浆脑钠素浓度差异。结果:AMI组患者血浆脑钠素浓度犤(416.7±208.0)ng/L犦明显高于对照组对犤(61.8±34.1)ng/L犦(t=2.9,P<0.01)。重构组血浆脑钠素浓度犤(466.3±211.2)ng/L犦明显高于非重构组对犤(301.5±198.7)ng/L犦(t=2.91,P<0.05);而且重构组急性期左室舒张末容积指数明显高于非重构组(t=3.32,P<0.01);左室射血分数明显低于非重构组(t=3.01,P<0.05)。血浆脑钠素浓度与恢复期左室容积指数呈正相关r=0.35,P<0.01)。(结论:AMI急性期血浆脑钠素浓度显著升高,且与AMI后心室重构有关。

AIM:To explore the association of brain natriuretic peptide(BNP) with left ventricular remodeling after acute myocardial infarction(AMI),so as to investigate the possible mechanism of BNP in predicting the prognosis of myocardial infarction. METHODS:Totally 110 patients(AMI group,78 males and 32 females),who met the inclusion criteria, were selected from 135 patients with first AMI hospitalized in the coronary care unit of the First Clinical Medical College of Harbin Medical Universion during January and July 2003.Other 25 healthy voluntary physical examinees(18 males and 7 females)at the same period were taken as the controls.The plasma concentrations of BNP were measured at the acute period of AMI in all the patients and the healthy controls,echocardiography(ECG) was conducted within 24 hours and 3 months after taking blood respectively.All the AMI patients were divided into remodeling group and non remodeling according to the changes of left ventricular volume index(LEVI) within 3 months.The ECG indexes were compared, and the difference of plasma concentrations of BNP between the remodeling group and non remodeling was observed. RESULTS:The plasma concentration of BNP was obviously higher in the AMI group[(416.7± 208.0) ng/L] than in the control group[(61.8 ± 34.1) ng/L](t=2.9,P< 0.01). The plasma concentration of BNP in the remodeling group[(466.3± 211.2) ng/L] was obviously higher than that in the non remodeling group[(301.5± 198.7) ng/L] (t=2.91, P< 0.05).The remodeling group had obviously higher left ventricular end diastolic volume index (LVEDVI) during the acute period (t=3.32, P < 0.01),but obviously lower left ventricular ejection function(LVEF)(t=3.01, P< 0.05) than the non remodeling group.The plasma concentration of BNP was positively correlated with LEVI at the recovery phase(r=0.35,P< 0.01). CONCLUSION:Plasma BNP concentration is markedly elevated during the acute period of AMI,and it is associated with the left ventricular remodeling after AMI.