择期介入治疗对急性心肌梗死患者N末端脑钠肽前体水平的影响及意义

Effect of Elective Percutaneous Coronary Intervention on N-terminal Pro-brain Natriuretic Peptide in Patients with Acute Myocardial Infarction

目的：探讨急性心肌梗死（ AMI）后不同时期行择期介入治疗（ PCI）对患者N末端脑钠肽前体（ NT-proB-NP）水平的影响及意义。方法选择起病48 h后行PCI的首发AMI患者64例,随机分为急性期组和非急性期组,分别于AMI后2～5d和5d以上进行PCI,检测所有患者PCI术前及术后24h的血浆NT-proBNP浓度。结果急性期组患者33例,包括ST段抬高型心肌梗死（STEMI）15例,非ST段抬高型心肌梗死（NSTEMI）18例；非急性期组31例,包括STEMI患者14例,NSTEMI患者17例。急性期组PCI术后24h的血浆NT-proBNP浓度较术前均显著降低,差异有统计学意义（P〈0．01）,其中NSTEMI患者的NT-proBNP下降率大于STEMI 患者,差异有统计学意义（P〉0．05）。非急性期组PCI术后24h的NT-proBNP水平高于术前,差异有统计学意义（P〈0．05）。结论 AMI急性期行PCI可使血浆NT-proBNP浓度明显降低,提示对AMI患者尤其NSTEMI患者来说于AMI后2～5d行PCI可能获益更大。

Abstract}： Objective To assess the influence of elective percutaneous coronary intervention （ PCI） performed at different stages of acute myocardial infarction （ AMI） on N-terminal pro-brain natriuretic peptide （ NT-proBNP） . Methods 64 consecutive patients with the aim of undergoing elective PCI at 24 hours after the onset of first AMI were randomly assigned to 2 groups, PCI was performed separately during the 2-5th day （ acute-phase group） and above 5 days （ non acute-phase group） after AMI. NT-proBNP was measured before and 24 hours post PCI. Results 33 patients in acute-phase group including 15 with STEMI and 18 with NSTEMI. 31 patients in non acute-phase group containing 14 with STEMI and 17 with NSTEMI. Plasma concentration of NT-proBNP in acute-phase group was decreased significantly at 24 hours following PCI （ P 〉0. 01 ） . Moreover, patients with NSTEMI seemed to have bigger drop in NT-proBNP （P〉0. 05）. NT-proBNP level on patients in non acute-phase group after PCI was higher than before （P〈0. 05）. Conclusion Elective PCI in acute phase of AMI can markedly reduce the level of NT-proB-NP, which suggest that PCI performed during the 2-5th day after AMI may be of much benefit to AMI patients especially to NSTE-MI patients.