急性心肌梗塞患者血浆脑钠素对存活心肌的评价

Plasma Concentration of Brain Natriuretic Peptide for Evaluation of Viable Myocardium After Myocardial Infarction

目的 :探讨急性心肌梗塞患者血浆脑钠素在评价存活心肌方面的临床价值。方法 :用放免法测定 6 0例急性心肌梗塞患者急性期及恢复期的血浆脑钠素 (brainnatriureticpeptide,BNP)浓度 ;进行 2 0 1铊 (2 0 1Tl)与12 3 碘 β 甲基碘苯脂十五烷酸 (12 3 I BMIPP)双核素同步心肌单光子发射断层显像对心肌梗塞区域进行半定量分析 ,根据再分布图像中2 0 1Tl与12 3 I BMIPP缺损积分将患者分为存活心肌组 (B组 )和对照组 (T组 )。进行99m锝 (99mTc) 心血池扫描测定急性期及恢复期左室射血分数。结果 :B组BMIPP负荷像与再分布像的缺损积分显著高于T组 (P <0 .0 1) ;B组恢复期血浆BNP浓度亦显著高于T组 (P <0 .0 1)并与BMIPP再分布像的缺损积分 (r =0 .6 5 ,P <0 .0 0 1)及Tl BMIPP分离度 (r=0 .6 2 ,P <0 .0 1)之间存在密切的相关。结论

Objective: Our aim was to evaluate the clinical value of the plasma concentrations of brain natriurtic peptide (BNP) in evaluating the viable myocardium after acute myocardial infarction. Methods: Sixty patients with acute myocardial infarction were included in this study. We recanalized the patients occluded coronary arteries successfully by coronary angioplasty. The plasma concentrations of BNP were measured with immunoradiometric assay (IRMA). 201 Tl and 123 I BMIPP dual single photon emission computed tomography (SPECT) were measured about 1 month after the onset of myocardial infarction. Tl and BMIPP uptakes were scored semiquantitatively from the stress imaging and the redistribution imaging. According to the defect scores of T1 and BMIPP, the patients were divided into 2 groups.Results: Defect scores of BMIPP were significantly higher in group B than those in group T. The plasma concentrations of BNP in convalescent phase were significantly higher in group B than those in group T and correlated significantly with defect scores of BMIPP and the difference of scores between T1 and BMIPP in redistribution imaging.Conclusion: Plasma concentrations of BNP are useful in evaluating the viable myocardium after acute myocardial infarction.