急性心肌梗死后心室重塑与脑钠肽的关系

Relation of ventricle remodeling and brain natriuretic peptide in patients with acute myocardial infarction

目的通过观察血浆脑钠肽(BNP)水平在急性心肌梗死(AMI)后的改变,了解BNP与心室重塑的关系,探讨血浆BNP测定可否作为预测AMI早期心室重塑的方法。方法AMI组:AMI患者37例,仅接受强化内科保守治疗;正常组为32例健康对照者。分别在AMI后72h、1个月及3个月,采用免疫荧光测定血浆BNP,并应用超声心动图检查测定射血分数(EF)、左室快速充盈速度(VE)、左房收缩峰值速度(VA)及VE/VA比值、左室舒张末期内径(LVEDd)、左室舒张末期容积(LVEDV);比较不同时期AMI组与正常对照组间各指标的差异。结果AMI后72h、1个月、3个月血浆BNP均值与对照组比较差异有统计学意义(P<0.01),均高于对照组,同时各AMI组之间差异亦有统计学意义(P<0.01);AMI 72h内血浆BNP水平与AMI后1个月、3个月心脏超声心功能指标之间的直线相关关系与EF、VE/VA表现为负相关,与LVEDd、LVEDV均表现为正向变化。结论心肌梗死患者72h内的血浆BNP与近期心肌梗死(心肌梗死后1个月、3个月)EF、VE/VA呈负相关,而与LVEDd、LVEDV呈正相关。心肌梗死患者早期血浆BNP水平可预测AMI近期心室重塑。

Objective To study the relationship between plasm BNP and cardiac structural, functional changes after AMI, and to evaluate the application of plasm BNP determination in predicting the early phase of ventricle remodeling after AMI. Methods AMI group included 37 patients,all patient underwent strict medical treatment, 32 healthy individuals were enrolled as controls. Plasm BNP was determinated by immunofluorescence. Eehoeardiogram examination was used to determinate LVEF,VE,VA,VE/VA,LVEDd,LVEDV, All patients underwent the examinations 72 h,30 days and 90 days after AMI occurred, respectively, and were compared with health controls. Results In comparing to controls, plasm BNP in AMI 72 h, 30 days and 90 days elevated significantly. LVEDd and LVEDV were increased significantly in all 3 phases of AMI, and EF, VE/VA were significantly lower than in controls, Correlation analysis revealed that plasm BNP level in 72 h after AMI was positive correlated to LVEDd,LVEDV,and was positive correlated to EF,VE/VA in 30 days and 90 days after AMI.Condusion Plasm BNP level in 72 h after AMI is a powerful index to predict left ventricle remodeling and ventricle function as plasm BNP level is positively correlated to ventricle remodeling,lowering the plasm BNP level might be used as a end point for treatment of heart failure.