AMI患者血浆BNP的水平与组织纤维化血清指标关系的研究

Relationship between plasma brain natriuretic peptide and serum fibrotic indices in acute myocardial infarction

目的：观察血浆脑钠尿肽（BNP）的水平以及血清Ⅰ型前胶原羧基端肽（PICP）、Ⅲ型前胶原（PCⅢ）在急性心肌梗死（AMI）后的改变，了解BNP与心脏胶原代谢的关系。方法：AMI患者组37例，仅接受强化内科保守治疗，正常对照组为32例健康体检者[平均年龄50～72（62．42±11．37）岁]，分别在AMI后72h、1个月及3个月，采用免疫荧光法测定血浆BNP的水平，ELISA测定血清PICP和PCⅢ的含量。结果：AMI后1个月、3个月的患者血清PICP的含量和AMI后72h、1个月、3个月的患者血清PCⅢ的含量均高于正常对照组。AMI后1个月、3个月的患者血清PICP的含量和AMI后各时间段血清PCⅢ的含量与AMI后各时间段血浆BNP的水平之间均呈正相关（PICP与BNP正相关：1月，r=0．394；3月，r=0．328。PCⅢ与BNP正相关：72h，r=0．389；1月，r=0．413；3月，r=0．396）。结论：AMI患者心脏胶原代谢活跃，与AMI后心功能不全关系密切，BNP可能参与了AMI患者心脏胶原代谢的调节。

AIM： To study the relationship between brain natriuretic peptide （BNP） and collagen metabolism after acute myocardial infarction （AMI） by observing the level of plasma concentrations of BNP and the indexes of myocardial fibrosis. METHODS： AMI group was comprised of 37 patients who were conservatively treated and 32 healthy individuals were used as controls. Plasma BNP was determined by immunofluorescence, and carboxy-terminal propeptide of procollagen type Ⅰ （PICP） and precollagen type Ⅲ （PC Ⅲ） were measured by enzyme-linked immunosorbent assay. Blood samples were obtained fi＇om the normal controls and from the patients at 72 h, 30 days and 90 days after AMI. RESULTS： Compared with those in the normal control group, in the medically treated group, serum levels of PICP 30 days and 90 days after AMI as well as PC Ⅲ after AMI increased and the increase was significantly correlated with plasma BNP. CONCLUSION： Collagen metabolism of the heart is activated after AMI, which is closely related to cardiac insufficiency and collagen remodeling. BNP may participate in the regulation of collagen metabolism after AMI.