急性心肌梗死患者急诊经皮冠状动脉介入治疗后NT-proBNP和QRS积分变化及预后

Changes of plasma N-terminal pro-B-type natriuretic peptide and QRS score in patients of acute myocardial infarction after emergent percutaneous coronary intervention and prognosis

目的观察急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后血浆N氨基末端脑钠肽前体(NT-proBNP)水平及心电图QRS积分变化情况,探讨其临床意义。方法 102例ST段抬高型AMI患者分为急诊PCI组(n=52)和常规药物保守治疗组(非PCI组,n=50),发病24小时采用酶联免疫吸附测定法检测血浆NT-proBNP水平,第7天查心电图测定QRS积分、查超声心动图测定左心室舒张末内径(LVEDD)及左心室射血分数(LVEF),比较两组上述指标的差异,分别对血浆NT-proBNP、QRS积分与LVEDD、LVEF进行相关性分析。结果与非PCI组比较,PCI组患者血浆NT-proBNP水平显著性降低(693.8±273.3)ng/L vs(378.9±183.7)ng/L(P<0.05),QRS积分显著性降低(6.4±0.5)分vs(5.5±0.4)分(P<0.01),LVEDD显著性降低(55.5±6.6)mm vs(47.2±5.2)mm(P<0.01),LVEF显著性增高(46.5±7.9)%vs(58.4±8.8)%(P<0.01)。血浆NT-proBNP水平与QRS积分呈正相关(r=0.428,P<0.01),与LVEDD呈正相关(r=0.421,P<0.01),与LVEF呈负相关(r=-0.402,P<0.05)。结论血浆NT-proBNP的增高能预测AMI面积及早期心室重构。

Objective To investigate the value of plasma N-terminal pro-B-type natriuretic peptide （NT proBNP） and QRS score in patients of acute myocardial infarction（AMI）. Methods 102 AMI patients with ST- segment elevation were divided into primary percutaneous coronary intervention（PCI） group（ n =52） and medicine group（ n = 50）, level of plasma NT-proBNP was measured after 24 hours of pain onset, QRS score,left ventricular enddiastolic（LVEDD） and left ventricular ejection fraction（LVEF） were detected on the seventh day. The level of plasma NT-proBNP, QRS score, LVEDD, LVEF were compared between two groups. The correlation of NT-proBNP and QRS score with LVEDD and LVEF were analyzed with regression analysis. Results The level of plasma NT-proBNP（693.8± 273.3） ng/L vs （378.9±183.7） ng/L（ P 〈0.05）,QRS score （6.4±0.5） scores vs （5.5±0.4） scores（ P〈0.01）, LVEDD （55.5± 6.6） mm vs （47.2 ± 5.2） mm（ P 〈0.01） of PCI group were significantly lower than those of medicine group, while LVEF was significantly higher than that of medicine group（46.5 ± 7.9）% vs （58.4 ± 8.8）% （ P 〈0.01）. The level of plasma NT-proBNP was positively correlated with QRS score （ r =0. 428, P 〈0.01） and LVEDD （ r =0. 421, P 〈0.01） ,negatively with LVEF （ r =0. 402, P 〈0.05）. Conclusion Plasma NT-proBNP can reflect earlier heart function,and it can predict the recent of prognosis patients with AMI.