不同再灌注情况首次急性前壁ST段抬高心肌梗死者血浆脑钠肽和左室重构的变化

The Correlation Of Left Ventricular Remodeling And Plasma Brain Natriuretic Peptide Undergoing Different Reperfusion In Patients With First ST-segment Elevation Acute Anterior Myocardial Infarction 1

目的为了探讨首次急性前壁ST段抬高心肌梗死者在不同再灌注情况下血浆脑钠肽和左室重构的关系。方法根据不同再灌注情况将56例患者分为3组：早期再灌注成功组、晚期再灌注成功组及再灌注失败组,各组于持续胸痛后准24小时、1个月测定血浆脑钠肽水平,于发病后24～72小时、1个月行超声心动图检查,测量左室舒张末容量、左室收缩末容量、左室射血分数,并通过计算得左室舒张末容量指数、左室收缩末容量指数,并获得1个月间的变量值。结果首次急性前壁ST段抬高心肌梗死者发病后24～72小时的血浆BNP水平高于正常对照组,晚期再灌注组及再灌注失败组高于早期再灌注组,而前两者无明显差异;发病后1个月时的BNP,再灌注失败组高于晚期再灌注组高于早期再灌注组。首次急性前壁ST段抬高心肌梗死者均发生近期左室重构,其程度与再灌注的情况相关,再灌注失败组重于晚期再灌注组重于早期再灌注组。首次急性前壁ST段抬高心梗后BNP水平与LVEDVI、LVESVI的变量值呈正相关,LVEF的变量值呈负相关,近期左室重构程度与发病后24～72小时的BNP值相关性大于发病后1个月的BNP值。结论首次急性前壁ST段抬高心肌梗死后血浆BNP水平与左室重构的程度均受再灌注情况的影响;血浆BNP与左室重构程度正相关,与左室收缩功能负相关。BNP是评价急性前壁ST段抬高心肌梗死后左室重构的生化指标。

Objective To study the correlation of left ventricular remodeling and plasma brain natriuretic peptide undergoing different reperfusion in patients with first st-segment elevation acute anterior myocardial infarction. Methods The study group included 56 patients with acute STE anterior myocardial infarction are derided into three groups： 32 patients with sucessfully early reperfusion （group A）, 14 patients with sucessfully late reperfusion （group B）, 10 patients with nonreprefusion. （group C）. Plasma BNP concentrations were measured with immunora- diometric assay at the twenty-fourth o＇ clock and lmonth afer AMI. LVEDV,LVESV、LVEF,LVEDVI,LVESVI were taken by Doppler echocardiography at the twenty-fourth to seventy-two o’ clock and 1 month after AMI. and we calculate their variables . We investigated plasma BNP concentrations and the echocardiography indexes and their relation at different time undergoing different reperfusion. Normal control group （ group D） owns 30 patients. Results The level of BNP is higher in group A, B, C than D, and in groupB , C than A at the twenty-fourth o＇ clock in patients with first st-segment elevation acute anterior myocardial infarction. There is no difference between group B and C. The early left ventricular remodeling exist in patients with first st-segment elevation acute anterior myocardial infarction. And the degrees are intimately related with different reperfusion treatment. Group C is heavier than group B. Group B is heavier than group A. 3 ,The level of BNP is positive related with the variables of LVEDVI、LVESVI, and negative related with the variables of LVEFo The related degree of left ventricular remodeling and BNP is higher at the twenty-fourth o＇ clock than at 1 month after AMI . Conclusion The level of plasma BNP and the degree of left ventricular remodeling are all influenced by different reprefusion. The level of BNP is positive related with the degree of left ventricular remodeling, and negative related with left ventricular systolic function. BNP is an excellent convenient and rapid index evaluating the degree of left ventricular remodeling after AMI.