溶栓治疗对急性心肌梗死后血浆脑钠肽水平及预后的影响

Influence of thrombolysis treatment on plasma natriuretic peptide level and prognosis after myocardial infarction

目的观察氨基末端B型脑钠肽(NT-pro BNP)水平在急性心肌梗死(AMI)患者溶栓前后的变化以及临床预后的影响,探讨其临床价值。方法 60例符合溶栓条件的急性心肌梗死患者,进行规范化静脉溶栓治疗,根据溶栓是否成功将患者分为溶栓成功组(40例)和溶栓未成功组(20例),记录1个月时的主要心血管事件,分别在入院即时和入院后12、24、48 h及14 d测定患者血浆NT-pro BNP水平。同时给予抗血小板、抗凝、扩张冠脉、稳定斑块、营养心肌、处理并发症等治疗。结果溶栓前两组NT-pro BNP水平差异无统计学意义(P>0.05)。溶栓后溶栓成功组NT-pro BNP水平明显低于溶栓未成功组,差异有统计学意义(P<0.01)。3个月内主要心血管事件的发生率明显低于溶栓未成功组,差异有统计学意义(P<0.05)。结论再灌注治疗能够显著降低急性心肌梗死患者血浆NT-pro BNP水平,减少心血管事件的发生。

Objective To observe changes of amino-terminal pro B-type natriuretic peptide （NT-proBNP） levels in acute myocardial infarction （AMI） patients before and after thrombolysis, and influence on clinical prognosis, and to investigate its clinical value. Methods There were 60 acute myocardial infarction patients receiving conventional intravenous thrombolysis treatment, and they were divided by successful thrombolysis into successful thrombolysis group （40 cases） and non-successful thrombolysis group （20 cases）. Main cardiovascular events in 1 month were recorded. Their plasma NT-proBNP levels were detected during admission, and in 12, 24, 48 h, and 14 d after admission. The patients also received antiplatelet, anticoagulation, coronary artery dilation, plaque stabilization, myocardial nutrition, and complications management for treatment. Results There was no statistically significant difference of NT-proBNP before thrombolysis between the two groups （P〉0.05）. After thrombolysis, the successful thrombolysis group had obviously lower NT-proBNP level than the non-successful thrombolysis group, and their difference had statistical significance （P〈0.01）. The successful thrombolysis group had lower incidence of main cardiovascular events within 3 months than the non-successful thrombolysis group, and their difference had statistical significance （P〈0.05）. Conclusion Reperfusion therapy can remarkably reduce plasma NT-proBNP level in acute myocardial infarction patients, and reduce incidence of cardiovascular events.