急性心肌梗死患者血浆BNP、ET、CRP、ANP水平变化与临床观察分析

Changes and analysis of the plasma levels of B-type natriuretic peptide,endothelins,C-reactive protein and A-type natriuretic peptide in the patients with acute myocardial infarction

目的 观察急性心肌梗死 (AMI)患者血浆中B型钠尿肽 (BNP)、内皮素 (ET)、C 反应蛋白 (CRP)、A型钠尿肽 (ANP)水平变化 ,为治疗及预后判断提供依据。方法 应用酶联免疫法及免疫放射分析法对 4 6例AMI患者治疗前后和 30名正常对照者血浆中BNP、ET、CRP、ANP水平进行检测。结果 AMI患者血浆中BNP、ET、CRP、ANP治疗前后比较差异有显著性 (P <0 .0 0 1) ,正常对照组与AMI治疗前比较差异有显著性 (P<0 .0 0 1) ,BNP与CRP在AMI治疗前水平呈正相关 (r =0 .874 ) ,治疗后呈明显的下降趋势 (r =0 .6 5 4 ) ,AMI治疗前后ANP与ET呈正相关 ,但AMI经溶栓和相应的支持治疗后ANP基本恢复到正常水平 (P >0 .0 5 ) ,而BNP、ET、CRP水平虽然下降明显 ,但与正常组比较差异仍有显著性 (P <0 .0 5 )。结论 AMI患者血浆中BNP、ANP、ET、CRP水平的变化说明其参与了AMI的发生、发展 ,特别是冠状动脉粥样斑块的形成和 (或 )破裂及血栓形成 ,其炎症因子是主要因素。因此 ,4项指标的观察分析对AMI治疗。

Objective To explore the pathogenesis and provide evidence for the diagnosis, therapy and prognosis of acute myocardial infarction (AMI) by observing the levels of B type natriuretic peptide (BNP), endothelins(ET), C reactive protein (CRP) and A type natriuretic peptide(ANP) in plasma of the patients. Methods BNP, ET, CRP and ANP levels in the plasma of 46 AMI patients before and after treatment and 30 normal controls were detected by ELISA and radioimmunoassay. Results There were significant differences between the patients with AMI before and after treatment in the levels of BNP, ET, CRP and ANP( P<0.001 ), and differences also in AMI group and control group ( P <0.001). There were positive correlation between BNP and CRP before treatment ( r =0.874) and after treatment ( r =0.654), as well as ANP and ET before treatment. Though the ANP level recovered to normal ( P > 0.05 ) after thrombolysis and other supporting therapy, the decreased BNP, ET and CRP were significantly higher than those in control groups ( P <0.05). Conclusions The changes of BNP, ANP, ET and CRP indicate that they are involved in the occurrence and development of AMI, especially in the information and disruption of atheromatous plaquemay and thrombosis. So the determination of BNP, ANP, ET and CRP levels are significant to the diagnosis, treatment and prognosis.