不同时间窗冠状动脉介入治疗对急性心肌梗死患者血浆N-末端利钠肽前体水平的影响

Effect of percutaneous coronary intervention at different time windows on N-terminal pro-brain natriuretic peptide in patients with acute myocardial infarction

目的探讨不同时间窗内行经皮冠状动脉介入治疗(PCI)对急性心肌梗死患者(AMI)血浆N-末端利钠肽前体(NT-proBNP)水平、左室射血分数(LVEF)和预后的影响。方法 65例AMI患者按发病后至急诊PCI时间分组:A组(≤12h)29例,B组(12～24h)36例。分别比较两组患者术后心力衰竭发生情况及病死率、血浆NT-proBNP水平的动态变化情况和超声心动图测定的LVEF。结果 A组患者的心力衰竭发生率和病死率均较B组明显降低,但经χ2检验,差异均无统计学意义(P均>0.05)。两组患者入院即刻的血浆NT-proBNP水平比较,差异无统计学意义(P>0.05)。而经过急诊PCI治疗后,入院后24h和7d两个时间点,A组患者的血浆NT-proBNP水平均明显低于B组患者,差异均具有统计学意义(P均<0.05)。同时,AMI发生后30d时的超声心动图检查也显示,A组患者的LVEF明显高于B组患者,差异具有统计学意义(P<0.05)。结论急诊PCI是AMI最有效的治疗手段,接受PCI的治疗时间越早,AMI患者术后心肌受损程度越轻,心肌收缩功能改善也越明显。

Objective To investigate the effect of percutaneous coronary intervention （PCI） at different time windows on N-terminal pro-brain natriuretic peptide （NT-proBNP）, left ventricular ejection fraction （LVEF）, and prognosis in patients with acute myocardial infarction （AMI）. Methods Sixty-five patients with AMI were divided into two groups according to the period from AMI attack to PCI treatment： group A （29 cases, P〈 12 h） and group B （36 cases, 12-24 h）. Incidence and mortality of heart failure, NT-proBNP level, and LVEF were detected and compared. Results Compared with the group B, the incidence and mortality of heart failure in the group A were decreased apparently, but showed no significant difference via variance test （all P〉0.05）. Observation comparing NT-proBNP levels revealed no significant difference between group A and B on admission （P〉0.05）, whereas at 24 h and on 7th d after PCI, we observed a marked decrease in the group A （all P〈0.05）. Meanwhile, LVEF in the group A were higher than the group B according to echoeardiogram examination on 30th d after AMI attack （P〈0.05）. Conclusions PCI is an effective method in the treatment of AMI. The myocardial damage would be slighter and the myocardial performance would be markedly improved if the patients with AMI received PCI earlier.