急性心肌梗死患者直接PCI治疗后心电图ST段抬高、BNP变化对左室重构的意义

The Clinical Importance to LVRM of Persistent Elevation of Electrocardiographic ST Segment and BNP Concentration in Acute Myocardial Infarction Patients after Primary PCI Therapy

目的观察急性心肌梗死（AMI）患者接受经皮冠状动脉介入治疗术（PCI）治疗后心电图ST段、血浆中BNP的水平变化与左室重构（LVRM）之间的关系，探讨心电图ST段、BNP对LVRM的预测价值。方法首次AMI患者共48例，比较PCI前及术后1h 12导联心电图抬高ST段的总和，按ST段下降幅度分为两组，A组：37例，ST段下降≥50％；B组：11例，ST段下降〈50％；治疗前及治疗后第7d，采用电化学发光法对血浆BNP水平进行检测；并随访复查AMI后2～3d及第3个月超声心动图。结果PCI治疗后BNP水平，A组明显小于B组；A、B组治疗前、后BNP间差异均有显著性意义（P〈0．05）。B组患者PCI治疗后2～3d及3个月时LVEDD比较，B组LVRM发生率与A组间差异均有显著性意义（P〈0．05）。结论急性心肌梗死患者直接PCI治疗后心电图ST段和BNP持续抬高对于预测左室重构有重要意义。

Objective To investigate the outcome prediction of BNP and ST segment to LV remodeling （LVRM） by observing the relation of the changes of ST segment in electrocardiograms and plasma BNP in cases with AMI after PCI operation with LVRM, Methods Forty - eight patients with a first AMI treated with primary PCI were selected. The extent of the ST segment elevation and resolution in electrocardiograms on admission and one hour after PCI was analyzed. All the patients were divided into two groups according to the extent of ST segment elevation and resolution. Group A： resolution of ST segment elevation ≥ 50%, n = 37 ; Group B ： resolution of ST segments elevation 〈 50% , n = 11 ; Plasma BNP levels was measured with eletrochemistry luminescent technique before PCI and at 7 days after PCI; echocardiogram was checked at 2 -3 days and 3 months after AMI. Results With PCI treatment, the plasma BNP levels in group A decreased significantly vs in group B; in group A, the plasma BNP levels after treatment decreased significantly vs before treatment; on the contrary in group B. In group A, there was no significant difference of LVEDD between at 2 -3 days after PCI and at 3 months after PCI; in group B, LVEDD at 3 months after PCI increased significantly vs that at 2 -3 days after PCI; the rate of LVRM in group B was bigger than that in group A. Conclusion The persist elevation of ST segment and the plasma BNP levels after PCI in AMI patien is clinically important for predicting the LVRM.