心肌梗死患者溶栓治疗中血浆BNP和D-二聚体水平的临床意义

The significance of BNP and D-dimer tests in thrombolytic therapy for patients with acute myocardial infraction

目的探讨心肌梗死患者溶栓治疗过程中血浆B型利钠肽(BNP)及D-二聚体水平检测的临床意义。方法采用全自动免疫荧光分析仪对该院确诊的心肌梗死患者于入院时(治疗前),治疗7d、14d及21d时分别测定患者血浆D-二聚体、BNP水平。患者经彩色多普勒确定心肌梗死面积大小并按梗死面积分为大、中、小面积梗死组3组,分析D-二聚体、BNP水平和心肌梗死面积的相关性。结果入院时小、中、大面积梗死组患者BNP水平分别为(165.0±26.3)、(237.0±39.4)、(413.0±61.2)pg/mL,组间比较差异有统计学意义(P<0.05)。各组患者入院时D-二聚体水平较正常参考水平明显升高(P<0.05)。溶栓治疗过程中D-二聚体水平呈现先升高,然后维持相对高水平,最后下降并恢复至正常参考水平的动态变化过程。结论心肌梗死面积与BNP水平有一定的相关性,动态监测D-二聚体水平可以用于溶栓治疗的效果评价。

Objective To investigate the significance of plasma B-type Natriuretic Peptide（BNP）and D-dimer test in thrombolytic therapy for patients with acute myocardial infraction（AMI）.Methods Determinated the plasma levels of D-dimer and BNP in patients diagnosed with AMI in the hospital by using full automatic immune fluorescence analyzer on admission（before treatment）,the 7th,14 the and 21 th day during treatment,respectively.Patients were divided into large,middle and small infarction group according to the infarct size determined by color Doppler.The correlation between BNP,D-dimer and infarct size were analysed.Results BNP levels in small,medium and large infarction group were（165.0±26.3）,（237.0±39.4）,（413.0±61.2）pg/mL,respectively,and the differences were statistically significant（P〈0.05）.The D-dimer plasma concentrations in the three groups were all higher than the normal reference level（P〈0.05）.In the course of thrombolytic therapy displayed a dynamic change process,the level of D-dimer increased first,then maintained at a relatively high level,and finally decreased and returned to the normal level.Conclusion The area of myocardial infarction has a certain correlation with the level of BNP,and the dynamic monitoring of D-dimer can be used to evaluate the effect of thrombolytic therapy.