床边快速测定B型尿钠肽预测左心室收缩舒张功能

目的　评估床边快速测定B型尿钠肽 (BNP)预测左心室收缩舒张功能的价值。方法　对 2 16例患者行免疫荧光法床边快速测定BNP ,随后进行超声心动图检查 ,根据临床及超声心动图结果将患者分成左心室功能正常组 ,左心室舒张功能不全组和左心室收缩功能不全组。比较各组间BNP值及计算BNP对预测左心室收缩舒张功能不全的敏感性和特异性。结果　左心室功能正常组BNP值为 (31± 2 7) pg/ml,收缩功能不全组为 (5 18± 4 2 7)pg/ml,舒张功能不全组为 (12 4± 78) pg/ml。左心室收缩功能不全时BNP与左心室射血分数有较强的负相关 ,(R =- 0 .731,P <0 .0 0 1)。BNP预测左心室收缩功能不全的接受运行特征 (ROC)曲线下面积为 0 .96 ,以BNP≥ 10 0 pg/ml预测心力衰竭的敏感性为 90 % ,特异性为 91%。BNP预测左心室舒张功能不全的ROC曲线下面积为 0 .90 4。以BNP≥ 4 0pg/ml来预测左心室舒张功能不全的敏感性为 79% ,特异性为 92 %。 结论　床边测定BNP能快速可靠地预测左心室收缩舒张功能。     

培哚普利对急性冠状动脉综合征患者白介素-6和肿瘤坏死因子-α水平的影响

目的　观察急性冠状动脉综合征患者使用培哚普利治疗后白介素 - 6( IL- 6)和肿瘤坏死因子 ( TNF- α)水平的变化。方法　选择 10 0例诊断为不稳定型心绞痛 ( 73例 )和急性心肌梗死 ( 2 7例 )的病人分为两组 ,A组 ( 5 0例 )接受培哚普利治疗 2周 ,B组 ( 5 0例 )未接受培哚普利治疗。入院时和治疗 2周后分别检测 IL- 6和 TNF- α浓度。结果　入院时 A组 IL- 6和 TNF- α水平与 B组相比无显著性差异 ( 60 8.4± 112 .3 pg/ ml vs5 83 .1± 10 6.4pg/ m l,46.0±10 .4pg/ ml vs 44 .1± 8.8pg/ ml,P>0 .0 5 ) ,治疗两周后两组 IL - 6和 TNF-α水平均有降低 ,而 A组病人两周后 IL -6和 TNF- α水平与 B组相比有显著降低 ( 2 40 .5± 5 0 .4pg/ ml vs414.3± 98.6pg/ m l,16.2± 3 .5 pg/ m l vs3 2 .7± 6.2 pg/ ml,P<0 .0 5 )。结论　急性冠状动脉综合征患者应用培哚普利治疗后 IL - 6和 TNF-α水平降低 ,提示培哚普利可能有直接抗炎作用     

急性冠脉缺血综合症患者血浆内皮素和内啡肽的变化及意义

目的 :观察急性冠脉缺血综合征 (ACIS)几种血浆介质的变化及意义。方法 :6 5例 ACIS患者被分为 AMI组(4 3例 ) ,不稳定型心绞痛组 (2 2例 ) ,于其发病后 12、 14、 48小时和 2 0天检查血肌酸激酶同工酶 (CK- MB)、内皮素 (ET)、β内啡肽 (β- EP)水平。结果 :ET峰值 :AMI组、心绞痛组分别为发病 12小时的 2 88.4± 80 .6 pg/ml,2 45 .1± 6 3.4pg/ml;β- EP峰值 :AMI组为 2 4小时的 2 10 .9± 5 0 .2 pg/ml,心绞痛组为 12小时的 15 4.2± 47.6 pg/ml;CK-MB>15 0 U/L 组 :β- EP2 40 .5± 42 .6 pg/ml,ET30 2 .4± 5 8.1pg/ml,明显高于 CK- MB<10 0 U/L组的 (P<0 .0 5 )。心功能 级患者 :β- EP 2 48.6± 2 7.3pg/m l,ET 311.6± 45 .2 pg/ml,明显高于心功能正常组 (P<0 .0 5 )。结论 :(1) ACIS发病后 β- EP在 2 4小时达到峰值 ,升高程度与心肌缺血坏死程度有关 ,它是 AMI后心衰的病理性介质之一 ;(2 ) ACIS发病后 ET迅速升高 ,12小时达到峰值 ,是急性损伤时的一种内源性致病因子 ,能诱发冠状动脉痉挛和血小板聚集。     

左心室舒张功能不全血清脑钠肽的改变及缬沙坦干预的作用

目的　探讨左心室(左室)舒张功能不全患者血清脑钠肽(BNP)水平改变和诊断价值,以及缬沙坦干预的作用。方法　用酶联免疫法测定30例单纯左室舒张功能不全患者(LVDD组)、20例左室收缩功能不全伴或不伴舒张功能不全患者(LVSD组)、20例心功能正常者(对照组)以及LVDD组缬沙坦干预10周后的血清BNP浓度。结果　LVDD组BNP水平明显高于对照组(186. 9pg/ml±125. 1pg/ml对68. 9pg/ml±29. 3pg/ml,P<0. 05),但明显低于LVSD组(186. 9pg/ml±125. 1pg/ml对879. 3pg/ml±453. 2pg/ml,P>0. 05 )。若左室收缩功能正常,BNP>120pg/ml判断单纯LVDD的敏感度为86. 7%,特异度为95%,阳性预告值为96. 3%,阴性预告值为82. 6%。缬沙坦治疗LVDD10周对BNP水平尚无明显影响(150. 1pg/ml±87. 5pg/ml对145. 9pg/ml±80. 2pg/ml,P>0. 05)。结论　血清BNP浓度在单纯LVDD患者亦明显升高,并有较好的诊断价值,缬沙坦治疗LVDD患者10周对BNP水平尚无明显影响。     

粉尘螨浸液免疫治疗螨性哮喘患者的免疫功能观察

目的　探讨粉尘螨变应原浸液免疫治疗对螨性哮喘患者免疫功能的影响。　方法　用粉尘螨浸液和平喘药分别对实验组和对照组螨性哮喘患者进行免疫治疗和对症治疗 ,用ELISA法检测患者治疗前、后血清总IgE、螨特异性IgE、螨特异性IgG、IL 2和IL 4水平 ,用生物素 链霉亲和素法检测患者治疗前、后外周血CD3 + 、CD4+ 、CD8+ 和CD4+ /CD8+ 。　结果　患者血清总IgE、螨特异性IgE、螨特异性IgG治疗前分别为 (2 92 .3 5± 112 .46)IU/ml、(2 5 1.68±12 5 .15 )IU /ml和 (5 87.64± 3 5 4.68)IU /ml ,治疗后分别为 (2 65 .74± 12 4.67)IU /ml、(2 97.5 6± 172 .2 7)IU /ml和(82 4.5 1± 42 8.2 6)IU /ml,两者相比 ,螨特异性IgG显著上升 (P <0 .0 1)。外周血CD3 + 、CD4+ 、CD8+ 、CD4+ /CD8+ 治疗前分别为 (5 5 .87± 7.2 3 ) %、(3 8.43± 6.43 ) %、(3 0 .14± 5 .2 4) %和 1.2 6± 0 .5 6,治疗后分别为 (65 .83± 6.5 5 ) %、(4 2 .72± 6.2 6) %、(2 8.5 7± 4.67) %和 1.5 8± 0 .62 ,CD4+ /CD8+ 比值上升 ,差异显著 (P <0 .0 5～P <0 .0 1) ;治疗前、后IL 2和IL 4的水平分别为 (2 .16± 0 .3 8) pg/ml、(3 .49± 0 .5 7) pg/ml和 (1.64± 0 .82 )pg/ml、(1.0 3± 0 .78) pg/ml ,差异均具显著性 (P <0 .0     

心肌缺血高压氧治疗对心脏起搏器的影响

为探讨高压氧对安装心脏起搏器的心肌缺血病人的治疗价值和安全性 ,前瞻性地分析了 38例安装心脏起搏器伴心肌缺血的病人高压氧治疗前后起搏阈值、心电图、血压及一氧化氮 (NO)、心钠素 (ANP)、血管紧张素Ⅱ(AT Ⅱ )的变化。结果 :高压氧治疗后 ,心肌缺血的心电图表现改善 ,总有效率为 92 .1% ;起搏阈值电压显著降低(1.6 2± 0 .6 8vs 1.91± 0 .6 1V ,P <0 .0 1)、脉宽显著变窄 (0 .2 5± 0 .12vs0 .2 9± 0 .10ms ,P <0 .0 1) ;NO由治疗前 5 7.89± 6 0 .82 μmol/L提高到治疗后 6 3.87± 48.0 7μmol/L(P <0 .0 1) ;ANP、AT Ⅱ起搏后显著降低 (分别为 179.95±5 2 .2 9vs 186 .37± 5 4.11pg/ml,P <0 .0 1;312 .37± 6 7.84vs 331.71± 75 .44pg/ml,P <0 .0 5 ) ,血压下降 (P <0 .0 1)。结论 :高压氧治疗可改善心肌缺氧 ,降低起搏阈值     

倍他乐克、洛汀新对心肌梗死后自主神经调控的影响

为评价倍他乐克、洛汀新对急性心肌梗死 (AMI)后自主神经的影响 ,并探讨其对AMI后心律失常的防治作用。 17条AMI模型狗被随机分为对照组、倍他乐克组和洛汀新组。测量AMI前、AMI后 1h和 4个月的心率变异(HRV) ,并在AMI后 4个月采用逐级右室快速起搏方法诱发心室颤动。时域分析指标以RR间期的标准差 (SDNN)和相邻RR间期差值平方和的均方根 (rMSSD)表示 ,频域分析包括高频 (HF 0 .15～ 0 .40Hz)、低频 (LF 0 .0 4～ 0 .15Hz)和极低频 (VLF 0 .0 0 33～ 0 .0 4Hz)。结果 :对照组中 ,SDNN、rMSSD、LF/HF在AMI后 4个月轻度恢复 ;倍他乐克组和洛汀新组在AMI后 4个月明显改善 ,与AMI后 1个月相比较 ,SDNN(188± 5 4vs 140± 44ms和 172± 32vs 12 7± 2 9ms)、rMSSD(32± 10vs 2 2± 5ms和 34± 8vs 2 3± 6ms)、HF(0 .48± 0 .0 2vs 0 .2 7± 0 .0 2ms2 和 0 .49± 0 .0 1vs 0 .2 7± 0 .0 1ms2 )、LF/HF(0 .6 5± 0 .0 3vs 1.74± 0 .15ms2 和 0 .6 7± 0 .0 3vs 1.6 9± 0 .11ms2 )差异有显著性 ,P均 <0 .0 5或 0 .0 1。三个实验组的心室颤动诱发率分别为 83% ,2 0 % ,3%。结论 :β受体阻断剂和血管紧张素转换酶抑制剂能改善AMI后的自主神经调控 ,防治AMI后室性心律失常的发生。     

心力衰竭患者血浆尾加压素Ⅱ与心钠素关系的研究

目的 :探讨不同程度心力衰竭患者血浆尾加压素Ⅱ、心钠素变化及其关系。方法 :放射免疫法检测 2 0例正常人 (对照组 )、45例心力衰竭患者 (心力衰竭组 ,心功能Ⅱ级 10例 ,Ⅲ级 15例 ,Ⅳ级2 0例 )血浆尾加压素Ⅱ和心钠素含量 ,超声心动图测定左心室射血分数、E峰与A峰比值 (E/A值 )。结果 :①对照组和心力衰竭组血浆尾加压素Ⅱ为 ( 4 3 5± 1 2 2 )pg/mlvs( 1 41± 1 0 9) pg/ml ,心钠素为 ( 4 1 82±6 0 9) pg/mlvs( 3 19 88± 3 0 2 1)pg/ml(P均 <0 0 0 1) ,均有极显著性差异 ;②心力衰竭组心力衰竭症状改善后 ,血浆尾加压素Ⅱ为 ( 1 90± 1 47) pg/ml,较治疗前 ( 1 41± 1 0 9) pg/ml升高 (P <0 0 5 ) ;治疗前后血浆尾加压素Ⅱ有正相关关系(r =0 5 63 ,P <0 0 0 1)。治疗后血浆心钠素为 ( 2 2 8 5 2± 2 2 0 1)pg/ml ,较治疗前明显降低 ,有显著正相关 (r =0 717,P<0 0 0 1) ;③血浆尾加压素Ⅱ含量减低、心钠素含量的升高与心力衰竭严重程度相平行 ;④血浆尾加压素Ⅱ含量与心钠素含量分别与心功能级别、左心室射血分数、E/A值有相关性。结论 :心力衰竭患者血浆心钠素含量升高伴有尾加压素Ⅱ含量下降 ,同时与心力衰竭程度平行 ,血浆尾加压素Ⅱ含量变化可以作为临床心力衰竭严重程度的客观指标     

血管内皮生长因子与冠心病的关系分析

目的 通过测定不同冠状动脉粥样硬化性心脏病(CHD)患者血清中血管内皮生长因子(VEGF)的水平,分析在不同情况下VEGF水平变化,并分析其与冠心病的关系.方法 选取诊断为CHD,并完成冠状动脉造影术患者142例,其中男性67例,女性75例,应用双抗夹心ELISA法检测患者血清VEGF水平.结果 不稳定型心绞痛(UAP)患者VEGF水平明显高于稳定型心绞痛(SAP)患者[(663.58±109.21)pg/ml和(537.47±29.37)pg/ml](P＜0.05);SAP患者与陈旧性心肌梗死(OMI)患者相比差异无统计学意义;SAP患者、UAP患者、OMI患者较冠状动脉造影正常者VEGF水平明显增高[(537.47±29.37)pg/ml、(663.58±109.21)pg/ml、(544.53±30.60)pg/ml和(463.58±60.12)pg/ml],(P＜0.05),而急性心肌梗死(AMI)患者发病第1天VEGF水平较SAP者无明显升高,但第2、3天VEGF水平较SAP者明显升高.结论 不同程度CHD患者中VEGF水平差异有统计学意义,VEGF与心肌缺血,以及缺血的时间密切相关,可能对于患者病情评价存在较大价值.     

冠状动脉介入或联合溶栓治疗急性心肌梗死的临床研究

目的探讨急诊冠状动脉介入治疗 (PCI)或联合溶栓治疗对急性心肌梗死 (AMI)的临床疗效。方法　对 3 3例AMI患者行直接PCI治疗 (PCI组 ) ,3 6例AMI患者在溶栓治疗的同时行直接PCI治疗 (溶栓 +PCI组 ) ,42例AMI患者行溶栓治疗 (溶栓组 ) ,比较各组住院和随诊期间的情况。结果　PCI组住院天数为 (9.3± 4.1)天 ,左心室射血分数 (LVEF)为 (4 5 .1± 4.2 ) % ;随诊期间 ,心绞痛发作 2例 ,择期再次PCI 2例。溶栓 +PCI组住院天数为 (9.2± 4.0 )天 ,LVEF为 (4 7.2± 4.1) % ;随诊期间 ,心绞痛发作 1例 ,择期再次PCI 1例。溶栓组住院天数为 (14 .0± 7.3 )天。LVEF为 (4 1.8± 6.4) % ;随诊期间 ,心绞痛发作 15例 ,择期PCI 14例。结论　AMI直接PCI或溶栓 +PCI可降低AMI的住院死亡率 (P <0 .0 1) ,缩短住院天数 (P <0 .0 5 ) ,有效保护心脏功能 (P <0 .0 1)。     

Expression of vascular endothelial growth factor in patients with acute myocardial infarction

OBJECTIVE: The purpose of this study was to investigate the clinical significance of vascular endothelial growth factor (VEGF) in acute myocardial infarction (AMI). We also examined the involvement of peripheral blood mononuclear cells (PBMCs), which are a possible source of VEGF in AMI. BACKGROUND: VEGF is a potent endothelial cell-specific mitogen and could affect the outcome of AMI. METHODS: Thirty patients with AMI were used for this study. Serum and PBMCs were isolated from peripheral blood on days 1, 7, 14 and 21 after the onset of AMI. PBMCs were cultured at a density of 5 x 10(6) cells/ml for 24 h. VEGF levels in serum and the culture media were measured by enzyme-linked immunosorbent assay using a specific anti-human VEGF antibody. RESULTS: Serum VEGF levels elevated gradually after the onset of AMI and reached a peak on day 14. VEGF levels in the culture medium of PBMCs after incubation for 24 h (PBMC-VEGF) were maximally elevated 7 days after the onset. Maximum serum VEGF levels showed significant positive correlations with maximum creatine phosphokinase (CPK) levels (r = +0.70, p < 0.001), but maximum PBMC-VEGF levels did not correlate with maximum CPK levels. Patients showing improvement in left ventricular systolic function during the course of AMI showed significantly higher PBMC-VEGF levels than patients without improvement. CONCLUSIONS: The extent of myocardial damage contributes to the elevation of serum VEGF levels in AMI. VEGF produced by PBMCs may play an important role in the improvement of left ventricular function by promoting angiogenesis and reendothelialization after AMI.     

急诊PCI对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响

目的探讨急诊经皮冠状动脉介入治疗（PCI）对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响。方法86例新发右束支传导阻滞的AMI患者随机分为急诊PCI治疗组（45例，观察组）及静脉溶栓治疗组（41例，对照组），分别于人院后24h、I周、1个月及3月行超声心动图检查，测量左心室舒张末期容积指数、左心室收缩末期容积指数和左心室射血分数。结果急诊PCI组与静脉溶栓治疗组于术后1个月及3个月左心室容积均减小，左心室射血分数升高；术后3个月两组左心室舒张期末容积指数[（63．4±5．8）ml／m^2比（67．3±6．4）ml／m^2]、左心室收缩期末容积指数[（30．5±3．4）ml/m^2比（34．6±4．0）ml／m^2]和左心室射血分数[（0．53±0．04）％比（0．50±0．02）％]，差异有统计学意义。结论急诊PCI治疗可明显抑制新发右束支传导阻滞的急性心肌梗死患者左室重构，改善左心室功能。     

PCI对恢复期心肌梗死患者左室重构的作用

目的评价经皮冠状动脉介入治疗(PCI)急性心肌梗死恢复期对患者左室重构的临床作用。方法对50例首次心肌梗死患者,平均于发病(3.8±2.1)周行冠状动脉造影,并进行前瞻性研究。按梗死相关冠状动脉是否进行PCI及PCI成功与否分为PCI组(28例PCI成功患者)和对照组(22例未行PCI患者)。对PCI组患者,于术前[平均(4.5±3.3)d]及术后随访期[平均(6.9±1.3)个月]及对照组患者于相当于PCI组术前和随访期时间进行心脏超声检查,以评价左室容量和收缩及舒张功能的改变。结果PCI组术后随访期左室容量较术前减小、左室收缩功能明显改善,而左室舒张功能无明显变化。与对照组相比,PCI组随访期左室容量较小,而收缩及舒张功能明显好于对照组。结论在心肌梗死恢复期,PCI尚能阻止患者的左室重构,改善患者的远期左室功能,具明显临床有益作用。     

Increased blood vascular endothelial growth factor levels in patients with acute myocardial infarction

Vascular endothelial growth factor (VEGF) is a growth factor for vascular endothelial cells in vitro. The present study was designed to determine whether serum VEGF levels increase in patients with acute myocardial infarction (AMI) compared with patients with stable exertional angina and control subjects, and to examine the serial changes of serum VEGF levels in patients with AMI. We examined serum VEGF levels by using antibody prepared from serum immunized with human VEGF(121). The serum VEGF level (pg/ml) was higher (p < 0. 0001) on admission in the patients with AMI (177 +/- 19) than in those with stable exertional angina (61 +/- 7) and control subjects (62 +/- 6). The serum VEGF level (pg/ml) of the patients with AMI was 177 +/- 19 on admission, 125 +/- 9 on day 3, 137 +/- 11 on day 5, 242 +/- 18 at 1 week, and 258 +/- 22 at 2 weeks after admission. The value was higher on admission than on day 3 after admission (p = 0.014), the values were higher at 1 week and 2 weeks than on admission, on day 3, and 5 (p < 0.01). Furthermore, there were correlations between peak VEGF levels at 1 week or 2 weeks after admission and peak creatine kinase levels. The increase of VEGF on admission in the patients with AMI may be due to the hypoxia of acute myocardial ischemia. The elevation at 1 week and 2 weeks from the onset may cause the development of collateral circulation in relation to the healing of the infarction site.     

Plasma levels of neuropeptide Y i patients with current myocardial infarction

Neuropeptide Y (NPY) has been recently characterised as one of the strongest circulating vasoconstrictor peptides, its elevated level may cause coronary artery spasm and increase of peripheral vascular resistance. All this contributes to ischemic myocardial damage and decrease of regional and global left ventricular function. The aim of the study was the examination of NPY plasma levels in patients with acute myocardial infarction (AMI) after thrombolytic therapy with or without reperfusion. The survey was made in 82 patients with AMI after thrombolytic therapy: 40 of them without reperfusion and 42 with reperfusion. The control group consisted of 20 healthy persons. Plasma levels of NPY were measured before thrombolysis, then 1, 3 and 5 days after, using a radioimmunologic method. All patients were treated with aspirin, glyceryl trinitrate and thrombolytic therapy (TT) with alteplase (r-TPA). In patients with AMI, NPY plasma levels were normal before and 1 day after TT, and were significant elevated 3 days after TT 5 days after TT, plasma NPY levels were still high in patients without reperfusion, but they decreased in patients with reperfusion. There was significant negative correlation between NPY level and left ventricular ejection fraction measured 5 days after AMI. During 30-days follow up systolic dysfunction of left ventricle with ejection fraction under 40% occurred in 21 patients and in 11 of them clinical symptoms of heart failure were observed. Using the multivariable regression analysis we showed that NPY concentration over 60 pg/ml is the independent factor leading to left ventricle systolic dysfunction. The results of our study suggest the contribution of NPY to the left ventricular remodeling after AMI.     

心肌梗死并心功能不全患者冠状动脉介入治疗的作用

目的 :评价心肌梗死 (MI)并左心功能不全患者经皮冠状动脉介入术 (PCI)对左心收缩功能和左心室重构的作用。方法 :5 2例MI并左心功能不全患者 ,急性心肌梗死 (AMI) 30例 ,陈旧性心肌梗死 (OMI) 2 2例 ,行经皮腔内冠状动脉成形术加支架术治疗 ,术后随访 3个月 ,超声心动图测定左室舒张末内径 (LVEd)、左心房内径(LAd)、左室舒张末容积 (LVEDV)、左室收缩末容积 (LVESV)、左室射血分数 (LVEF)和左室短轴缩短率 (LVFS) ,比较治疗前后各参数的变化。结果 :PCI治疗后LVEd、LAd、LVEDV、LVESV较治疗前均明显减少 (均P <0 .0 1)、LVEF和LVFS明显增高 (P <0 .0 1) ,尤以AMI组明显 ,并且冠状动脉血运重建的时间越早 ,心功能恢复越好。结论 :MI并左心功能不全患者尽早PCI治疗可明显改善左心室收缩功能 ,部分阻抑左心室重构。     

缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术中心肌的保护作用

目的 探讨心肌缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术（PCI）中心肌的保护作用。方法 选择首次发生急性心肌梗死的患者105例,随机分为观察组（缺血后适应组）及对照组,均接受急诊PCI。对照组行常规PCI;观察组PCI术中设置缺血后适应方式。测定两组术前及术后肌酸激酶（CK）及肌酸激酶同工酶（CK-MB）水平;测量术后左心室舒张期末容积指数(LVEDVI)、左心室收缩期末容积指数(LVESVI)、左心室射血分数(LVEF);观察术后严重心律失常、梗死后心绞痛、住院期间病死率发生情况。结果 与对照组比较,观察组术后CK及CK-MB峰值水平明显减低;术后3个月左心室容积减小, LVEDVI ［（64±6）ml/m2 vs （67±6）ml/m2,P＜0.05］,LVESVI［（30±4）ml/m2 vs （34±4）ml/m2,P＜0.05］,LVEF升高（0.53±0.02 vs 0.50±0.03,P＜0.05）;严重心律失常、梗死后心绞痛明显减低,差异有统计学意义（P＜0.05）;住院期间病死率的差异未达到显著水平。结论 心肌缺血后适应对急性心肌梗死PCI术中心肌有保护作用。     

Clinical significance of brain natriuretic peptide in patients with postmyocardial infarction

BACKGROUND: Risk stratification after acute myocardial infarction (AMI) includes the evaluation of left ventricular (LV) function. Natriuretic peptides, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI. HYPOTHESIS: Brain natriuretic peptide levels are related to ventricular function, either systolic or isolated diastolic, and can give prognostic information in patients surviving AMI. METHODS: In all, 101 patients were enrolled. An echocardiographic (M-mode, two-dimensional, and pulsed Doppler) evaluation was performed and blood samples for BNP measurement were obtained. Clinical events were recorded during 12 months of follow-up. RESULTS: A negative correlation between BNP and LV ejection fraction was observed (r = -0.38; p < 0.001). The BNP levels were higher among patients with LV systolic dysfunction than in patients with isolated diastolic dysfunction (339.1 +/- 249.9 vs. 168.0 +/- 110.5 pg/ml, p = 0.001). The latter had higher levels of BNP than those with normal LV function (68.3 +/- 72.6 pg/ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was good (area under the ROC curve [AUC] = 0.83) and increased when isolated diastolic dysfunction was also considered (AUC = 0.87). Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the development of heart failure (AUC = 0.90). CONCLUSION: These results extend previous evidence relating BNP to systolic function after AMI. Furthermore, a relationship between BNP levels and diastolic function was found. Brain natriuretic peptide had a very good performance in detecting the occurrence of an adverse event. We conclude that BNP can detect high-risk patients and help select patients for more aggressive approaches.     

急诊介入治疗对急性心肌梗死患者血清VEGF、Fg及hsCRP的影响

目的：探讨急诊介入治疗对急性心肌梗死（AMI）患者血管内皮生长因子（VEGF）、纤维蛋白原（Fg）及超敏c-反应蛋白（hsCRP）的影响。方法：采用酶联免疫吸附法（EI。ISA）检测60例行急诊经皮冠状动脉介入（PCI）治疗的AMI患者术前及术后血清VEGF、Fg及hsCRP的含量。结果：与治疗前相比,AMI患者急诊介入治疗后VEGF[（134．5±30．1）pg／ml比（101．5±25．4）pg／m1]水平明显降低（P〈0．05）、Fg[（4．76±0．24）mg／L比（5．40±0．26）]mg／L]及hsCRP[（2．93±0．38）mg／I。比（5．06±0．60）mg／L]水平明显升高（P均〈0．05）。结论：血管内皮生长因子、超敏C-反应蛋白、纤维蛋白原水平与急性心肌梗死PCI相关,对上述指标进行联合检测,对评定AMI患者PCI病情、判断预后可能有重要价值。