经皮冠状动脉介入治疗对急性心肌梗死患者氨基末端脑钠尿肽原及心功能的影响

Effects of percutaneous coronary intervention on level of N-terminal pro-brain natriuretic peptide and heart function in patients with acute myocardial infarction

目的:研究急性心肌梗死(AMI)患者接受急诊及择期经皮冠状动脉介入治疗(PCI)后血浆氨基末端脑钠尿肽原(NT-proBNP)水平变化及其与心功能的关系。方法:入选2009年7月～2010年12月,发病后12 h内接受急诊PCI治疗的ST段抬高型心肌梗死(STEMI)患者94例,住院期间未行第2次PCI治疗者为A组(n=46),住院期间第5～7天行第2次PCI治疗者为B组(n=48);发病后24 h内入院的AMI患者未行再灌注治疗者为C组(n=34);使用电化学发光测量不同时间NT-proBNP水平,同时测量心肌梗死后不同时间左室舒张末期直径(LVEDD)、左室收缩末期容积(LVSDV)、左室舒张末期容积(LVEDV)及左室射血分数(LVEF)。结果:A、B两组各时间点NT-proBNP水平较C组明显下降,LVEDD、LVSDV、LVEDV、LVEF在45 d及6个月时较C组明显下降,差异有统计学意义(P<0.05);同时,B组NT-proBNP水平在45 d及6个月时与A组相比进一步下降,LVEDD、LVS-DV、LVEDV、LVEF测量值则进一步改善,两组差异也有统计学意义(P<0.05)。结论:STEMI患者行PCI后NT-proBNP水平有显著下降趋势,且NT-proBNP水平可以作为患者心功能预测因子,后续的择期PCI治疗能进一步降低NT-proBNP及改善心功能。

AIM： To investigate the effects of percutaneous coronary intervention （PCI） on the level of N-terminal pro-brain natriuretic peptide （NT-proBNP） and the heart function in patients with acute myo- cardial infarction （AMI）. METHODS： One hundred and twenty-eight patients with AMI were divided into group A of primary PCI （ n = 46）, group B of primary and selective PCI （ n = 48 ） and group C of conventional treatment （n = 34 ）. Plasma NT-proBNP was measured by electrochemiluminescence in these patients immediately, 24 h, 5 days, 11 days, 45 days and 6 months after admission. Patients underwent ultrasound electrocardiogram examination at the 12th -15th day, 45th day and 6＇h month. RESULTS： NT-proBNP levels after PCI in group A and group B were significantly lower and heart func- tion was better than those in group C （P 〈 0. 05 ）. NT-proBNP levels of group B were lower than those in group A at the 45th day and 6^th month （P 〈 0.05 ）. The results of ultrasound electrocardiogram at the 45th day and 6^th month showed a significant difference in left ventricular end-diastolic diameter （LVDd）, left ventricular end systolic volume （LVESV）, left ventricular end diastolic volume （LVEDV） and left ven- tricular ejection fraction （LVEF） between group A and group B （P 〈 0. 05 ）, whereas no significant difference was seen at the 12^th - 15th day. CONCLUSION： NT-proBNP level in patients with AMI declines after PCI and can be used as a predictor of cardiac function and ventricular remodeling. Subse- quent elective PCI treatment may further reduce the NT-proBNP level and improve heart function.