急性心肌梗死患者血浆脑钠肽与左室室壁瘤形成和心功能的关系

Plasma level of brain natriuretic peptide and the its relationships to the left ventricular aneurysm formation and cardiac performance in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)急性左室室壁瘤形成患者血浆脑钠肽(BNP)的动态变化特点及其与左室室壁瘤形成和心功能状态的关系。方法首次前壁 AMI 患者64例,经左心室造影后分为左室室壁瘤组31例和无左室室壁瘤组33例。分别于发病后6 h、12 h、18 h 和1 d、2 d、3d、5 d 及24周采血检测 BNP,并于经皮冠状动脉介入治疗(PCI)完成后6个月时再行左心室造影,检测有创容积和压力各参数。随访6个月内的主要恶性心脏事件发生率。结果左室室壁瘤组发病后6 h、第5 d 和第24周血浆 BNP 浓度均明显高于无左室室壁瘤组(均为 P<0.05)。在相同血流动力学情况下,无论左室舒张末期压(LVEDP)是否升高(≥18 mm Hg),左室室壁瘤组患者 BNP 的峰值浓度均明显高于无左室室壁瘤患者。PCI 后即刻和术后6个月时,无左室室壁瘤组左室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、每一节段室壁运动记分(WMS)和 LVEDP 各参数均高于无左室室壁瘤组。左室室壁瘤组 BNP 峰值水平与 PCI 后即刻 LVESVI、LVEDVI、WMS 和 LVEDP 呈显著正相关(r=0.56、0.60、0.52、0.77,均为 P<0.01),与 LVEF 呈显著负相关(r=0.72 P<0.01)。左室室壁瘤组恶性心脏事件发生率明显高于无左室室壁瘤组患者(均为 P<0.05),且 BNP 峰值水平与恶性心脏事件发生率亦有显著相关(r=0.58,P<0.05)。结论血浆 BNP 水平在 AMI 后左室室壁瘤形成患者中明显高于无左室室壁瘤者,且与左室重构程度和血流动力学变化密切相关,提示 AMI 后 BNP 的过度分泌参与了 AMI 后左室重构和左室室壁瘤的形成,并影响着其后的心室功能。

Objective To investigate the plasma level of brain natriuretie peptide（BNP） and its relationships with the left ventrieular aneurysm （LVA）formation and cardiac performance in acute myocardial infarction （AMI） patients. Methods A total of sixty four patients[51 male, 13 female, age （64.8 ±12.2）years3 with primary anterior AMI-aeeompanied LVA diagnosed by left ventrieulography （LVG）were enrolled in this study and divided into LVA group （33 patients） and non-LVA group （31 patients）. Plasma BNP levels were measured at 6,12,18 hours, 1, 2, 3, 5 days and 24 week after onset of the AMI. Immediately after PCI and 6 months after AMI,the parameters of LVEDVI, LVESVI, LVEF,WMS and LVEDP were measured by LVG. The main adverse cardiac events （MACE）were recorded during 24 weeks after PCI. Results （1）The peak value of plasma BNP in LVA group was higher and the arrived time of peak values of plasma BNP was earlier than those in the non-LVA group（P〈0. 01, respectively）. In 5th day and 24th week after AMI, the values of BNP in LVA group were higher as compared to those in non-LVA group （P〈0.05, respectively）. （2）The peak value of plasma BNP in LVA group, regardless of whether LVEDP≥18 mmHg or LVEDP〈18 mm Hg, were higher than that in non-LVA group under the same level of LVEDP. At 6th month after AMI, the parameters of LVEF, LVESVI, LVEDVI, WMS and LVEDP in non-LVA group were much higher as compared to those in LVA group. （3）The peak value of plasma BNP was significantly positively correlated with LVESVI, LVEDVI, WMS, LVEDP in LVA group （r=0. 56, 0. 60, 0. 52, 0. 77, P〈0.01, respectively）, while negatively correlated with LVEF at primary PCI （r= -0. 72, P〈0. 01）. （4）During the 6 months follow-up, the incidence of MACE in LVA group was higher than that in the non-LVA group （P〈0.05）. The peak value of plasma BNP in LVA group was significantly correlated with the incidence of MACE （r=0. 58,P〈0. 05）. Conclusions The value of plasma BNP in the AMI patients with LVA is higher as compared to that in non-LVA, and significantly correlated with left ventricular remodeling status and homodynamic change. The over secretion of BNP is involved in the left ventricular remodeling and the process of LVA formation.