急诊冠状动脉介入治疗对急性心肌梗死患者脑钠肽水平的影响

Brain natriuretic peptide and left ventricular remodeling after emergency percutaneous coronary intervention in acute myocardial infarction patients

目的观察急诊冠状动脉介入治疗（PCI）对急性心肌梗死患者血浆脑钠肽（BNP）水平的影响，并进一步探讨其对左室重构的影响。方法急性心肌梗死患者118例，其中PCI组52例，在发病后6～12h内成功行急诊PCI；保守治疗组66例，为同期拒绝急诊PCI或急诊PCI失败者。两组均于入院即刻，12、24、48和72h以及7、14和28d测定血浆BNP浓度；采用多普勒超声诊断仪测量两组患者入院3～5d和28d的左室射血分数（LVEF）。以同期20例健康体检者的检测值作为正常参考值。结果两组患者入院即刻血浆BNP水平均高于正常健康者，同组不同时间点BNP浓度比较差异亦有统计学意义（P均〈0．01）。保守治疗组血浆BNP水平呈双峰曲线，12～24h达高峰，7d时出现第二次峰值。PCI组血浆BNP水平呈单峰曲线，于12～24h达到峰值。PCI组各时间点BNP水平均显著低于保守治疗组（P均〈0．01）。两组患者3～5d的LVEF值比较差异无统计学意义；28d时PCI组LVEF值明显高于保守治疗组（P〈0．01）。结论急诊PCI能够降低急性心肌梗死患者血浆BNP水平，提高LVEF值，从而减轻左室重构。

Objective To investigate the effect of emergency percutaneous coronary interventional （PCI） treatment on plasma brain natriuretic peptide （BNP） levels and left ventricular remodeling in patients with acute myocardial infarction （AMI）. Methods This study included 118 patients with AMI and 20 healthy volunteers （their results were regarded as normal reference）. Fifty-two patients who underwent successful emergency PCI 6- 12 hours after onset were named as PCI group, and 66 patients rejected or in whom emergency PCI failed served as the control group. Plasma BNP levels were determined with Triage rapid assay at admission,at 12, 24, 48, 72 hours and 7, 14, 28 days after admission for both groups. Left ventricular ejection function （LVEF） was assessed by echocardiography with the modified Simpsonts equation on 3 - 5 days and 28 days. Same assay was performed for 20 healthy volunteers. Results Plasma BNP levels of both groups were significantly higher at admission than those of volunteers. There was significant difference in BNP levels between two groups at corresponding time points （all P〈0.01）. In PCI group, BNP level peaked during 12- 24 hours after admission, whereas two peaks of elevation of BNP levels were detected in control group, the first peak appeared during 12- 24 hours and the second peak on 7 days after admission. Plasma BNP levels in PCI group were significantly lower than those of control group at corresponding time pionts （all P〈0.01）. There was no difference in LVEF level between two groups on 3 - 5 days after admission. LVEF level after emergency PCI was significantly higher than that of control group on 28 days after admission （P〈0. 01）. Conclusion Emergency PCI lowers plasma BNP level and improve LVEF level in patients with AMI, and it may reverse ventricular remodeling.