急性心肌梗死急诊介入术后脑钠肽变化

目的:探讨急性心肌梗死(AMI)急诊冠状动脉(冠脉)介入(PCI)术后脑钠肽(BNP)变化趋势。方法:收集经急诊PCI的初发AMI患者80例为AMI组,同期收集冠脉造影正常者30例为对照组,采用双抗体夹心法测定血清BNP浓度。按照Gensini积分系统将AMI组分为:轻度、中度、重度冠脉病变组。结果:①AMI组与对照组术前BNP水平比较差异无统计学意义(P>0.05);AMI组术后12hBNP与对照组比较差异具有统计学意义(P<0.05);术后3d,AMI组BNP浓度明显高于对照组(P<0.05),而术后第7天,AMI组与对照组比较差异无统计学意义(P>0.05);②AMI发生后,其分泌模式多数仍为双相性模式,但峰值有所前移,可能跟早期急诊PCI术开通罪犯血管、挽救濒临坏死心肌、降低室壁张力有关;轻度病变组(Gensini积分<40分)绝大多数仅有一个峰值,发生在AMI后14～20h,而重度冠脉病情组(Gensini积分>80分)多数存在两个峰值,第2峰值一般在AMI发生后3d左右。结论:在PCI干预下,重度冠脉狭窄病变患者BNP呈"双相分泌模式",而轻度冠脉病变者多数为"单相性分泌模式"。

Changes of BNP after emergency PCI in patients with AMI

Objective:To explore the change of BNP after emergency PCI in patients with AMI. Method:80 AMI patients were recruited as AMI group,and 30 patients with normal CAG results were collected as control group.Double-Antibody Sandwich was used to detect the level of BNP.According to Gensini System,AMI group was divided into three subgroups: light degree,mid-degree,heavy degree group. Result:①There was no significant change between AMI group and control group before PCI and 7 days after PCI(P>0.05).However,for 12 hours and 3 days after PCI,plasma concentration of BNP was higher obviously in AMI group than in control group(P<0.05).②When AMI occurred,secretion of BNP usually had two peak values,with peak value appearing ahead of normal time.For heavy degree group,Two peak value of BNP occurred with the second value commonly appearing after three days of AMI.However for light degree,there was mostly one peak value. Conclusion:Because of PCI effect,heavy degree groupmay usually presents "biphasic secretion pattern",however,light degree group only presents "single-phase secretion pattern".