急性心肌梗死的心肌再灌注血流与脑钠肽的关系

Relationship between myocardial reperfusion flow in patients after acute myocardial infarction and brain natriuretic peptide

目的探讨急性心肌梗死(AMI)心肌血流再灌注水平与血浆脑钠肽(BNP)水平的关系及其临床意义。方法对67名AMI成功行急诊介入治疗(PCI)的患者分别进行TIMI心肌灌注分级(TMPG)、心肌灌注显影分级(MBG)和校正的TIMI血流帧数计数(CTFC),采用荧光免疫抗原抗体结合方法测定发病24h即刻血浆脑钠肽(BNP)水平并评价其相互关系。结果TMPG方法评定的心肌灌注水平中,TMPG0/1级组12例,TMPG2级组29例,TMPG3级组26例,其对应血浆BNP平均水平分别为(1026±1119)ng/L,(346±192)ng/L和(219±95)ng/L。各组间血浆BNP水平差异有统计学意义(P=0·001)。其中TMPG0/1级组血浆BNP水平分别高于TMPG2级组和TMPG3级组(P<0·01,P<0·001);TMPG2级组高于TMPG3级组(P<0·01)。MBG方法评定的心肌灌注水平中,MBG0/1级组22例,MBG2级组25例,MGG3级组20例,其对应血浆BNP平均水平分别为(735±886)ng/L,(343±137)ng/L和(148±65)ng/L。各组间血浆BNP水平差异有统计学意义(P<0·001)。其中MBG0/1级组血浆BNP水平分别高于MBG2级组和MBG3级组(P<0·05,P<0·001);MBG2级组高于MBG3级组(P<0·001)。CTFC方法评定的冠脉血流中CTFC>40帧组20例,CTFC≤40帧组47例,血浆BNP平均水平分别为(453±265)ng/L和(397±650)ng/L,CTFC>40帧组血浆BNP水平高于CTFC≤40帧组(P=0·0036)。结论AMI患者心肌血流再灌注水平与血浆BNP水平负相关,再灌注水平越低组血浆BNP水平越高。心肌缺血损伤是BNP释放的重要刺激因素。

Objective To explore the variation and significance of brain natriuretic peptide in different levels of myocardial repeffusion flow in patients with acute myocardial infarction after successful primary. angioplasty. Methods The study included 67 AMI patients treated with primary, angioplasty. Assessment of repeffusion included Corrected TIMI Frame Count （CTFC）, TIMI Myocardial Peffusion Grading （TMPG） and TIMI Myocardial Blush Grades （MBG）. Plasma BNP levels were measured by fluomimmtmoassay 24 hours after symptom onset. Results Angiography assessment of reperfusion by TMPG were divided into 3 groups （TMPG 0/1, TMPG 2 and TMPG 3）. There were 12 patients with TMPG 0/1, 29 patients with TMPG 2 and 26 patients with TMPG 3. The plasma BNP level among the TMPG 0/1, TMPG 2 and TMPG 3 group were statistically different （ 1 026 ± 1 119 ng/L, 346 ± 192 ng/L, 219 ± 95 ng/L respectively; P = 0.001 ）. The plasma BNP level in TMPG 0/1 group was higher than that in TMPG 2 group and TMPG 3 group （ P 〈 0.01, P 〈 0.001 respectively）. The plasma BNP level in TMPG 2 group was higher than that in TMPG 3 group （ P 〈 0.01 ）. The assessment of reperfusion by MBG were also divided into 3 groups （MBG 0/1, MBG 2 and MBG 3 ）. There were 22 patients with MBG 0/1, 25 patients with MBG 2 and 20 patients with MBG 3. The plasma BNP levels among the 3 groups of MBG 0/1, MBG 2 and MBG 3 were significantly different （735 ± 886 ng/L, 344 ± 137 ng/L, 148 ± 65 ng/L respectively; P 〈 0.001 ）. The plasma BNP level in MBG 0/1 group was higher than that in MBG 2 group and MBG 3 group （ P 〈 0.05, P 〈 0.001 respectively）. The plasma BNP level in MBG 2 group was higher than that in MBG 3 group （P 〈 0.001 ）. Evaluation of reperfusion by CTFC were devided into 2 groups according to the number of frames. Patients with CTFC 〉 40 frames （ n = 20） were joined as one group while patients with CTFC≤40 frames （ n = 47） were joined as another group. The plasma BNP level in patients with CTFC 〉 40 frames was higher than that in patients with CTFC≤40 frames （ P = 0.003 6）. Conclusion The level of myocardial perfusion is negatively correlated with the plasma BNP level. The lower the level of myocardial perfusion, the higher the plasma BNP. Ischemia hypoxia may be an important stimulus for BNP release in human cardiac myocytes.