氨基末端脑钠肽前体对急性心肌梗死患者的预后评价

Value of N-terminal pro-brain natriuretic peptide in prognostic evaluation in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)及溶栓治疗后血浆氨基末端脑利钠肽前体(NT-proBNP)水平变化趋势及对预后判断的价值。方法发病后24h内入院的ST段抬高型AMI患者188例,根据患者最终选择的治疗方式分为四组:A组(n=50):行急诊PCI治疗,住院期间第5～7d行第二次PCI治疗;B组(n=48):仅行急诊PCI治疗;C组(n=46):给予静脉溶栓治疗,住院期间第5～7d行择期PCI治疗;D组(n=44):仅给予静脉溶栓治疗。测量不同时间点患者血浆NT-proBNP水平。根据患者入院24hNT-proBNP值,将患者分为:0～299pg/ml组、300～899pg/ml组及≥900pg/ml组,记录三组患者住院期间、随访半年内及1年内的主要不良心脏事件(MACE)。对PCI术后NT-proBNP水平与随访1年时冠状动脉支架内再狭窄的关系进行了研究。结果四组患者入院24hNT-proBNP水平均达峰值,随后呈逐渐下降趋势。A、B两组比较,AMI后45d、半年、1年时NT-proBNP水平差异有统计学意义(P<0.05);C、D组与A、B组比较,入院后各时间点NT-proBNP水平均有统计学差异(P<0.05);C、D两组比较,AMI后第11d、随访第45d、半年及1年时NT-proBNP水平差异有统计学意义(P<0.05)。NT-proBNP水平0～299pg/ml、300～899pg/ml及≥900pg/ml三组患者住院期间、随访半年及1年时MACE发生率均呈递增趋势;其中0～299pg/ml组、300～899pg/ml组患者MACE发生率无统计学差异(P>0.05);而此两组与≥900pg/ml组比较,MACE发生率均有统计学差异(P<0.05)。随访1年时发生冠状动脉再狭窄患者各时间点NT-proBNP水平明显高于未再狭窄患者,其差异有统计学意义(P<0.05)。结论 NT-proBNP水平对预测急性心肌梗死患者PCI及溶栓治疗后近、中期预后及1年时冠状动脉再狭窄具有临床价值;急诊PCI及择期二次PCI对降低NT-proBNP水平优于溶栓治疗。

Objective To investigate the change tendency of level of serum N-terminal pro-brain natriuretic peptide（NT-proBNP） and its value to prognosis in patients with acute myocardial infarction（AMI） after percutaneous coronary intervention（PCI） and thrombolytic treatment.Methods The patients with AMI and ST-segment elevation（n=188） hospitalized within 24 hours after disease onset were divided into 4 groups according to their finally selected therapies：group A（n=50） having emergency PCI and second PCI within 5 days to 7 days after hospitalization,group B（n=48） only having emergency PCI,group C（n=46） having intravenous thrombolytic treatment and selective PCI within 5 days to 7 days after hospitalization,and group D（n=44） only having intravenous thrombolytic treatment.The level of serum NT-proBNP was detected at different time points.According to the value of NT-proBNP after hospitalizing for 24 hours,the patients were divided into group with NT-proBNP from 0 pg/mL to 299 pg/mL（0～299 group）,group with NT-proBNP from 300 pg/mL to 899 pg/mL（300～899 group） and group with NT-proBNP over 900 pg/mL（over 900 group）.The major adverse cardiac events（MACE） were recorded in three groups during hospitalization,follow-up for six months and follow-up for one year.The relationship between the level of NT-proBNP after PCI and restenosis in coronary stent after follow-up for one year was studied.Results The level of NT-proBNP reached peak value in all patients within 24 hours after hospitalization,and then tended to decrease.The comparison between group A and group B showed that the difference in NT-proBNP level had statistical significance（P〈0.05） after AMI for 45 days,six months and one year.The comparison between group A-group B and group C-group D showed that NT-proBNP level had statistical difference（P〈0.05） at all time points after hospitalization.The comparison between group C and group D showed that the difference in NT-proBNP level had statistical significance（P〈0.05） 11 days after AMI,and after follow-up for 45 days,six months and one year.The incidence of MACE manifested a progressive tendency in 0～299 group,300～899 group and over 900 group.Between 0～299 group and 300～899 group the incidence of MACE had no statistical difference（P〉0.05）,while it had statistical difference（P〈0.05） when 0～299 group or 300～899 group compared with over 900 group.The level of NT-proBNP was significantly higher in the patients with coronary restenosis than those without coronary restenosis（P〈0.05） at all time points after follow-up for one year.Conclusion The level of NT-proBNP is valued to the prediction of short-term and mid-term prognosis,and coronary restenosis after one year in AMI patients with PCI and thrombolytic treatment.The emergency PCI and selective second PCI have better effects than thrombolytic treatment in decreasing the level of NT-proBNP.