急诊经皮冠状动脉介入术对急性心肌梗死患者血浆B型钠尿肽的影响

Effect of primary percutaneous coronary intervention on plasma B-type natriuretic peptide in patients with acute myocardial infarction

目的探讨急诊经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者血浆B型钠尿肽(BNP)的影响。方法选择2002年6月至2003年12月在我院监护中心住院的38例AMI患者,分成急诊PCI组(A组)26例,非再灌注治疗组(B组)12例。在入院时和入院后第1、7、30天采用荧光免疫法(FIA)分别测血浆BNP浓度,A组只干预相关梗塞血管,B组按一般常规治疗。结果两组病人在入院和入院后1dBNP水平均升高(A组:243.74±75.68,283.42±88.66;B组:228.65±82.32,275.48±89.67),但两者比较无差异,P>0.05;7d后,A组下降,B组仍维持高水平(203.63±59.42对388.74±108.52,P<0.05);30d后,A组下降明显,B组BNP亦有下降,但比较仍有非常显著差异(96.31±43.22对237.66±75.48,P<0.01);急诊PCI干预不同梗死相关血管(IRA)时,血浆BNP变化亦不同,干预前降支较右冠脉和回旋支BNP下降更明显。LVEF和LVEDD的变化和BNP的变化相对应。3例死亡病例血浆BNP水平均高于正常10倍以上。结论AMI患者经急诊PCI再灌注治疗后血浆BNP在7d开始下降,30d下降更为显著。

Objective To observe the effect of primary percutaneous coronary intervention （PCI） on plasma B-type natriuretc peptide （BNP） in patients with acute myocardial infarction （AMI）. Methods Thirty-eight patients with AMI were divided into two groups for PCI （n=26） and conventional treatment （n=12）. The plasma BNP levels were measured by fluorescence immunoassay （FIA） in these patients immediately, 24 h, 7 d, and 30 days after admission, and the infarct-related coronary arteries （IRA） were treated only with emergency interventional therapy in PCI group. Results BNP of the patients in the PCI and conventional treatment group B increased immediately and 24 h after admission, but there was no significant difference between the two groups （243.74±75.68 vs 228.65±82.32 and 283.42±88.66 vs 275.48±89.67, P〉0.05）. BNP in PCI group decreased but that in conventional treatment group increased 7 days after admission, showing significant difference between them （203.63±59.42 vs 388.74±108.52, P〈0.05 ）. BNP remained significantly lower in the PCI group than in the other group 30 days after admission （96.31±43.22 vs 237.66±75.48, P〈0.01）. Emergency PCI for different IRA resulted in the significant difference in BNP between the patients, and intervention of the left anterior descending artery （LAD） resulted in more obvious BNP reduction in comparison with that due to interventional of the right coronary artery （RCA） and left circumflex coronary artery （LCX）. The changes in left ventricular ejection fraction （LVEF） and left ventricular end-diastolic dimension （LVEDD） were correlated to the changes of BNP. The mean BNP in the 3 fatal cases was nearly 10-fold higher than the normal level. Conclusions BNP of AMI patients decreases on days 7 and 30 after reperfusion therapy with primary PCI, and the reduction can be more obvious 30 days after admission.