早期应用螺内酯对行急诊介入治疗的急性心肌梗死患者的影响

Effects of early spironolactone treatment in patients with acute myocardial infarction expecting to proceed primary percutaneous coronary intervention

目的：探讨早期应用螺内酯治疗对行急诊介入治疗的急性心肌梗死（AMI）患者的短期影响。方法：入选行急诊介入治疗的AMI患者201例,在常规治疗的基础上随机分为螺内酯组100例及对照组101例。所有患者在治疗前及治疗后1、3个月检测血浆醛固酮和Ⅲ型前胶原肽（PⅢNP）、B型脑钠肽（BNP）及N端B型脑钠肽前体（NT-proBNP）,统计BNP〉200pg/ml和（或）NT-proBNP〉450（年龄〈50岁）、〉900（年龄50~75岁）、〉1 800pg/ml（年龄〉75岁）的发生率。监测血钾、肾功能。结果：治疗1、3个月时两组血浆醛固酮均被抑制,螺内酯组被抑制得更明显（均P〈0.05）;两组PⅢNP水平均较治疗前显著增长,对照组较螺内酯组增长更明显（均P〈0.05）;BNP〉200pg/ml和（或）NT-proBNP〉450（年龄〈50岁）、〉900（年龄50~75岁）、〉1 800pg/ml（年龄〉75岁）的发生率,螺内酯组较对照组明显减少（均P〈0.05）。两组均无严重高钾血症发生,螺内酯组低钾血症发生率较对照组明显减低（P〈0.05）。结论：对行急诊介入治疗的AMI患者早期应用螺内酯可进一步降低血浆醛固酮、PⅢNP水平,减少BNP和（或）Pro-BNP升高的发生率,且在严格监测下应用安全。

Objective：To investigate the effects of early spironolactone treatment in patients with acute myocar- dial infarction expecting to proceed primary percutaneous coronary intervention. Method： There were 201 acute myocardial infarction patients expecting to proceed primary percutaneous coronary intervention were enrolled and randomly assigned to s pironolactone group （n= 100）and control gaoup（n = 101）. The plasma aldosterone and Nterminal procollagenⅢ propeptide （PⅢ NP）, brain natriuretic peptide （BNP） and N-Terminal B-type natriuretic peptide （NT-proBNP） were examined, as well as the incidences of BNP〉200 pg/ml and/or NT-proBNP〉450 （aged 50 years）, 〉 900 （age 50 - 75 years）, 〉 1 800 pg/ml （ age 〉 75 years） were calculated before and after 1, 3 months of therapy. The serum potassium and renal function were monitored. Result： After 1 and 3months of treat- ment, plasma aldosterone was suppressed in the two groups, and spironolactone group was suppressed more signif- icantly（P〈0. 05） ;PⅢ NP increased signicantly in the two groups and control group increased more significantly（P 〈0.05） ;the incidence of BNP〉200 pg/ml and/or NT-proBNP〉450（age〈50 years） ,〉900（age 50-75 years）, 〉1800 pg/ml（age）,75 years）in spironolactone group was lower than that in control group（P〈0.05）. There was no severe hyperkalemia occurred in the two groups, the incidence of hypokalemia in spironolactone group was sig- nificantly lower than that in control group. Conclusion.. Early treatment of spironolactone can depresse plasma aldo- sterone and PHI NP, Inhibiti the elevation of BNP and （or） Pro-BNP in patients with acute myocardial infarction expecting to proceed primary percutaneous coronary intervention. It is safe in rigorous monitor.