急性心肌梗死患者经皮冠状动脉介入治疗围术期应用重组人脑利钠肽后脑利钠肽和肌酸激酶同工酶变化及安全性观察

Variation of brain natriuretic peptide and CK-MB levels in acute myocardial infarction patients after primary percutaneous coronary intervention

目的观察急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术中及术后静脉应用重组人脑利钠肽（rhBNP）48h后帆浆脑利钠肽（BNP）和肌酸激酶同工酶（CK—MB）的变化及rhBNP的安全性。方法选择70例AMI患者，随机分为rhBNP治疗组（A组）和牛理盐水对照组（B组）。两组患者均行直接PCI术，A组：PCI术中及术后静脉应用rhBNP，先按1．5μg/kg负荷剂量静脉推注（〉3min），后按0．01μg·kg^-1·min“静脉滴注，持续48h;B组：PCI术中及术后应用牛理盐水静脉滴注同期对照。同时观察静脉应用过程中患者有无血压下降、头痛、腹部不适、恶心呕吐等。两组在PCI术前、术后检测血浆BNP及CK—MB浓度。结果（1）B组血浆BNP浓度高峰在PCI术后24h出现。在PCI术后156h两组血浆BNP浓度[B组（137±24）ng／L，A组（115±35）ng／L]差异有统计学意义（P=0．023）。（2）A组术后60h CK—MB较B组明显降低（P〈0．0S）。（3）相关分析显示，BNP与性别（r=0．303，P=0．024）、年龄（r=0．522，P〈0．001）呈正相关，与体质量（r=-0．504，P〈0．001）、左心室射血分数（LVEF）（r=-0．317，P=0．032）呈负相关。（4）A组在应用rhBNP中出现不良反应14例，B绀为16例，差异无统计学意义（P=0．784）。结论AMI患者PCI同术期应用rhBNP安全可行；应用rhBNP可能减轻心肌损伤；血浆BNP浓度女性较男性高，与年龄旱正相关，与体质量、LVEF旱负相关。

Objective To observe the safety of intravenous recombinant human brain natriuretic peptide （rhBNP） and variations of BNP and CK-MB levels in acute myocardial infarction （AMI） patients during and after primary percutaneous coronary intervention （PCI）. Methods Seventy AMI patients received standard drug therapy and primary PCI, were randomly divided into two groups. Group A received rhBNP 1.5 μg/kg intravenous injection in more than 3 minutes,then continuous infusion at 0. 01 μg· kg^-1·min^-1 for 48 hours; Group B received saline infusion at the same rate as group A. During the infusion, the following side effects were observed： hypotention, headache, nausea, etc. Plasma BNP and CK-MB levels were measured pre- and post-PCI. Results （1 ） In group B, the peak concentration of plasma BNP was observed 24 hours post-PCI. Plasma BNP level was significant different 156 hours post-PCI between group A and group B （P =0. 023）. （2） Subgroups analysis showed that serum CK-MB in group A was significantly decreased 60 hours post-PCI compared with that in group B（ P 〈 0. 05 ）. （3） Serum BNP was positively correlated with age, sex （ r = 0. 522,P 〈 0. 001 ; r = 0. 303, P = 0. 024）, and negatively correlated with body weight, LVEF （ r = - 0. 504, P 〈 0. 001 ; r = - 0. 317,P = 0. 032）. （4） Fourteen patients presented with side effects during rhBNP infusion in group A, 16 patients in B group. There was no significant difference between 2 groups （P = 0. 784）. Conclusions Intravenous therapy of rhBNP in AMI patients recieved primary PCI was feasible and safe. Intravenous infusion of rhBNP during and after PCI might decrease cardiac injury.