急性心肌梗死患者经皮冠状动脉介入治疗前后脑利钠肽水平的变化及其意义

The changes of brain natriuretic peptide level and its significance in patients with acute myocardial infarction before and after primary percutaneous coronary intervention

目的研究急性心肌梗死（AMI）患者接受经皮冠状动脉介入（PCI）治疗前后血浆脑利钠肽（BNP）水平变化及其与心功能、心室重构的关系。方法入选2005年9月至2008年3月，发病后12h内接受急诊PCI治疗的ST段抬高急性心肌梗死患者102例，直接PCI前及直接PCI后第7天采用酶联免疫法测定患者血浆BNP水平，并按治疗后第7天血浆BNP水平将患者分为3组：A组低于100pg／ml，B组100—400pg／ml，C组高于400pg／ml，PCI治疗后6个月对患者进行超声心动图检查。结果PCI治疗后BNP水平较治疗前明显下降；3组患者PCI治疗后6个月的超声心动图比较，患者左室射血分数、左室舒张末期容积、左室收缩末期容积C组与A、B组差异有统计学意义（P〈0．05），B组与A组比较差异无统计学意义（P〉0．05）。结论AMI患者直接PCI后BNP水平有显著下降趋势，且BNP水平可能可以作为患者心功能及心室重构的预测因子。

Objective To investigate the changes of brain natriuretic peptide（BNP） of patients with acute myocardial infarction before and after percutaneous coronary intervention （ PCI ） and its relationship with cardiac function and ventricular remodeling. Methods One hundred and two patients with ST-segment elevation myocardial infarction were successfully reperfused by primary PCI within 12 hours after onset. BNP plasma level of the patients was measured with enzyme-linked immunoassay before and 7 days after PCI. According to the BNP level of patients 7 days after PCI, the patients were divided into 3 groups： group A（ 〈 100 pg/ml） ; group B （100 -400 pg/ml） ; group C（ 〉400 pg/ml）. The patients underwent ultrasound electrocardiogram examination 7 days and 6 months after PCI. Results BNP level of patients after PCI was significantly lower than that before PCI. The results of ultrasound electrocardiogram 6 months after PCI were compared among three groups ： the left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume of patients had significant difference between group C and group A, B（ P 〈 0. 05 ） ; while it didn＇t have significant difference between group A and group B （P 〉 0. 05 ）. Conclusion BNP level in patients with acute myocardial infarction declined after direct PCI, and may be used as the predictor of cardiac function and ven- tricular remodeling of patients.