急性下壁心肌梗死患者血B型利钠肽的研究

Study of serum B-type natriuretic peptide in patients with acute inferior myocardial infarction

目的:探讨急性下壁心肌梗死(AIMI)患者伴或不伴有右心肌梗死与血浆B型利钠肽(BNP)水平的相关性。方法:入选AIMI患者213例,依据临床表现、心电图和冠状动脉造影将213例AIMI患者分为伴有右心室梗死组(A组)和单纯AIMI组(B组),另选同时期住院冠状动脉造影正常者98例作正常对照组。测定各组及AIMI中不同病变部位者BNP水平,并对不同BNP水平患者进行住院期间、30d、3个月死亡事件及主要心脏不良事件的临床观察。结果:A组血浆BNP水平明显高于B组(P<0.01)。右冠状动脉近段和中段病变患者血浆BNP水平显著高于左回旋支病变患者(P<0.01)。AIMI患者中血浆BNP水平升高独立于各因素预测30d和3个月病死率及心脏不良事件发生率(r=0.7010,95%CI:<0.01～0.615,P<0.01)。结论:BNP水平可能对AIMI伴右心室梗死有预测作用。

Objective： To investigate the relationship between the level of serum B-type natriuretic peptide （BNP） and right ventricular infarction in patients with acute inferior myocardial infarction （AIMI）. Method：The serum BNP level was measured in 213 consecutive patients with AIMI who were admitted in the coronary care unit （CCU） and in the normal control with 98 cases from October 2006 to May 2009. The patients Were divided into five groups in accordance with the coronary angiographic findings and electrocardiogram （ECG） ： Acute inferior myocardial infarction group; acute inferior myocardial infarction and right ventricular infarction group; control group; left anterior circumflex （LXC） group; proximal, middle and distal segment of right coronary artery （RCA） group. All patients were performed directly percutaneous coronary intervention （PCI） within 24 hours after the onset of AIMI. The incidence of major adverse cardiac events （MACE）, including arrhythmia, heart failure, cardiac shock and mortality, had been observed during hospital,30 days and 3 months. Result：BNP level in the acute inferior myocardial infarction and right ventricular infarction group wassignificantly higher than that in acute inferior myocardial infarction group （P〈0.01）. The level in the proximal-mid segment of RCA group was higher than that in the LXC group （P〈0.01）. Additionally, logistic regression analysis showed that the level of BNP was an independent predictor of MACE in the 30 days and 3 months in acute inferior myocardial infarction patients （r =0. 701 0, 95% CI〈0. 01-0. 615, P〈0. 01）. Conclusion：We demonstrated the level of BNP in patients with acute inferior myocardial infarction or/and right ventricular infarction, and BNP could be a good predictor for patients with acute inferior myocardial infarction and right ventrieular infarction.