ST段抬高型心肌梗死患者纤维蛋白原和D-二聚体的相关研究

目的:探讨ST段抬高型心肌梗死(STEMI)患者与冠状动脉造影阴性的对照组纤维蛋白原和D-二聚体含量的差异。方法:选取2007-01-2008-08间STEMI并行直接冠状动脉介入治疗术(PCI)患者161例。同时选取冠状动脉造影阴性的对照组161例,比较2组间纤维蛋白原和D-二聚体含量。结果:STEMI患者血浆纤维蛋白原含量(2.47±0.89)g/L低于对照者(2.79±0.69)g/L,差异有统计学意义(t=-3.62,P<0.01)。STE-MI患者D-二聚体含量(μg/L)的平方根(10.96±5.66)高于对照者(9.13±5.04),差异有统计学意义(t=3.07,P<0.01)。STEMI患者血浆D-二聚体含量(μg/L)与纤维蛋白原含量(g/L)比值的平方根(7.52±4.56)高于对照者(5.63±3.29),差异有统计学意义(t=4.26,P<0.01)。结论:STEMI患者的纤维蛋白原低于冠状动脉造影阴性的对照组,D-二聚体高于对照组,提示在STEMI急性期存在急性血栓形成和继发性纤溶。     

Late activation of the fibrinolytic system in myocardial infarction treated with thrombolytic therapy: Influence of the coronary anatomical substrate

Procoagulant activity, thrombin and fibrinolytic system activationhave been demonstrated in the first 24–48 h after acutemyocardial infarction treated with thrombolytic therapy. Littleis known about what happens in the subsequent days, during whichthe incidence of ischaemic recurrence is high. In 21 patients treated with streptokinase and in 20 patientstreated with urokinase we evaluated, with multiple plasma determinations,D-dimer and fibrinogen plasma levels in the first week aftermyocardial infarction. From the 2nd hour after the begrnningof thrombolysis to the 4th day, all patients received intravenousheparin in doses sufficient to raise the partial thromboplastintime to twice its normal level; subcutaneous calcium heparin(12 000 U/day) was subsequently substituted for the intravenousroute. Coronary angiography was performed 7 days after infarction.From the basal values 2·22 ± 1·44 nmol.1^–1 in the strep tokinase group and 3·28 ±3·05 nmol . 1^–1 in the urokinase group, D-dimerrose consistently in the 1st hour after thrombolysis 269·4± 206·7 nmol . 1^–1 and 44·5 ±35·5 nmol . 1^–1 in the streptokinase and urokinasegroups, respectively; P<0·00l. After the peak value,which in both groups was reached after 5 h, D-dimer slowly decreasedduring the study period. It reverted to normal values only in10/21 patients in the streptokinase group; in the urokinasegroup normalization was attained in 14/20 patients between the3rd and 6th days. After withdrawal of i.v. heparin in patientsof both groups with TIMI 0 or 1 grade of coronary patency, D-dimerrose to levels four to seven times greater than normal; in patientsof both groups with TIMI 2 or 3 grade coronary flow, D-dimershowed a monophasic pat tern of progressive normalization (P<0·05and P<0·0l at the 6th and 7th days, respectively,for differences between TIMI 0–1 and TIMI 2–3 groups). After myocardial infarction, thrombolysis is followed by activeand persistent fibrin degradation more marked and lasting afterstreptokinase than after urokinase. When occurring sooner, itis a consequence of plasmin activation induced by thrombolyticagents; later it seems to be related to intracoronary substrate,as suggested by the relation ship of plasma elevation of D-dimerwith the presence of occluded or subocciuded infarction-relatedvessels.     

链激酶治疗老年急性心肌梗死的临床分析

目的　探讨链激酶 (SK )治疗老年急性心肌梗死 (AMI)患者的疗效。方法　对 138例链激酶静脉溶栓治疗的患者进行临床分析 ,按年龄分组 ,对溶栓后冠状动脉再通率、心脏事件发生率、病死率及出血并发症作临床分析。结果　 >6 5岁组的患者其血管再通率、心脏事件发生率、病死率及出血并发症与≤ 6 5岁的患者比较差异无显著性 [(70 .5 %比 77.7% (P >0 .0 5 ) ;40 .9%比 40 .4% (P >0 .0 5 ) ;15 .9%比 10 .6 % (P >0 .0 5 ) ;11.4%比 10 .6 % (P >0 .0 5 ) ]。结论　链激酶静脉溶栓治疗老年急性心肌梗死患者安全可行 ,但要视每位患者具体情况而定。     

重组链激酶治疗急性心肌梗死的疗效和安全性

目的　探讨老年急性心肌梗死患者接受重组链激酶溶栓治疗的疗效和安全性。方法　 2 5 5例急性心肌梗死患者分为老年组 (15 7例 )和非老年组 (98例 ) ,分别对两组的临床疗效进行比较。结果　非老年组与老年组比较 ,其梗死相关血管再通率 (81.6 %vs79.0 % )、梗死后心绞痛 (8.2 %vs7.6 % )、再梗死 (2 .0 %vs3.2 % )、严重心律失常(11.2 %vs10 .8% )、心源性休克 (5 .1%vs5 .1% )、出血 (2 3.5 %vs2 1.7% )及其他并发症的发生率均无显著性差异(P >0 .0 5 )。结论　老年急性心肌梗死接受重组链激酶溶栓治疗是安全、有效的。     

Prognostic value of plasma C-reactive protein and fibrinogen determinations in patients with acute myocardial infarction treated with thrombolysis

OBJECTIVES: To investigate the prognostic value of plasma C-reactive protein (CRP) and fibrinogen determinations in patients with acute myocardial infarction treated with thrombolysis. DESIGN: Longitudinal study of morbidity and mortality. SETTING: Coronary care unit at Danderyd Hospital, Stockholm, Sweden. SUBJECTS: A total of 222 patients aged 75 years or below, treated with thrombolysis because of typical symptoms of myocardial infarction and electrocardiogram showing ST-segment elevation or bundle branch block were included in the study. The patients were followed for 24-60 months (mean 40 +/- 16 months). MAIN OUTCOME MEASURES: Cardiovascular death or new myocardial infarction. RESULTS: Concentrations of CRP were significantly higher at 48 h than at 3 months, whilst the levels of fibrinogen were similar. CRP and fibrinogen concentrations measured during the acute phase of myocardial infarction were associated with cardiovascular death or a new myocardial infarction during follow-up in univariate analysis. CRP levels measured 3 months after the acute event were not associated with subsequent events whereas fibrinogen concentrations showed a borderline prognostic significance (P = 0.05). When CRP and fibrinogen were entered into multivariate analysis together with the previously established prognostic factors in the patient group (age, diabetes mellitus and left ventricular function), these markers of inflammation did not add further prognostic information. CONCLUSION: C-reactive protein and fibrinogen do not carry the same independent prognostic information after acute myocardial infarction treated with thrombolysis as in studies previously reported for patients with unstable angina or non-Q-wave myocardial infarction.     

急性心肌梗死患者溶栓治疗前后血清一氧化氮含量变化

目的：探讨急性心肌梗死（ Ａ Ｍ Ｉ）患者血清一氧化氮（ Ｎ Ｏ）含量变化及其临床意义。方法：在２８例 Ａ Ｍ Ｉ患者接受尿激酶静脉溶栓治疗前及治疗后３ ｈ 分别测定其血清一氧化氮（ Ｎ Ｏ）、超氧化物岐化酶（ Ｓ Ｏ Ｄ）及丙二醛（ Ｍ Ｄ Ａ）的含量变化。结果：溶栓治疗后３ ｈ 的 Ｎ Ｏ、 Ｓ Ｏ Ｄ 含量较治疗前含量显著减少（ Ｐ ＜ ０．０５）。 Ｍ Ｄ Ａ 含量显著增加（ Ｐ ＜ ０．０５）。尤以冠状动脉再通组 Ｎ Ｏ、 Ｓ Ｏ Ｄ 含量减少（ Ｐ ＜ ０．０１）, Ｍ Ａ Ｄ 含量增加（ Ｐ ＜ ０．０１）更明显。而未通组在治疗前后的 Ｎ Ｏ、 Ｓ Ｏ Ｄ、 Ｍ Ｄ Ａ 含量无显著性差异（ Ｐ ＞ ０．０５）。结论： Ｎ Ｏ、 Ｓ Ｏ Ｄ 含量减少, Ｍ Ａ Ｄ 含量增加与缺血心肌再灌注损伤有关,在对 Ａ Ｍ Ｉ患者行溶栓治疗同时,应同时积极采取抗氧化治疗。     

链激酶溶栓治疗急性心肌梗死对左心室功能的改善作用

为评价链激酶溶栓治疗急性心肌梗死（ＡＭＩ）对左心室功能的影响，应用二维超声心动图对２６例接受链激酶溶栓治疗的ＡＭＩ患者和２７例未溶栓的ＡＭＩ患者，分别在急性期及６个月后随访时测量并计算左心室容积（ＥＤＶ和ＥＳＶ），射血分数（ＥＦ）以及室壁运动指数（ＧＷＭＩ和ＲＷＭＩ）。以上各项指标在急性期时比较各组无显著性差异；在随访期再通组ＥＦ值明显高于未通组和未溶栓组，再通组左室容量减小。急性期各组心功能无差异，随访时再通组心功能较未通组显著改善。提示:链激酶溶栓能明显减轻ＡＭＩ患者的左心室扩张，改善左心室功能和长期预后     

Streptokinase antibodies inhibit reperfusion during thrombolytic therapy with streptokinase in acute myocardial infarction

OBJECTIVES: To evaluate the influence of pretreatment IgG against streptokinase on the outcome of streptokinase treatment in acute myocardial infarction. SETTING: Coronary care unit. DESIGN: From 88 patients admitted to the coronary care unit due to chest pain, blood samples were taken for determination of the pre-existing titre of antibodies against streptokinase. The patients were treated and monitored according to standard protocols. Fifty of the patients received thrombolytic therapy with streptokinase due to acute myocardial infarction and were monitored with continuous dynamic vectorcardiography, making possible the continuous analysis of ST- and QRS-vector changes and determination of the event of reperfusion. None of these 50 patients had been given streptokinase therapy previously. RESULTS: According to the vectorcardiographic criteria 21(42%) patients had signs of early (within 2 h) reperfusion after streptokinase therapy. These patients had lower pre-existing antibody titres than patients without signs of reperfusion (mean values 0.20 and 0.45 arbitrary units, P = 0.01). None of the patients with a titre higher than 0.50 arbitrary units (nine patients) had signs of early reperfusion. Of the 41 patients with a titre lower than 0.50 arbitrary units 52.5% had signs of early reperfusion. CONCLUSION: The present investigation indicates that pre-existing streptokinase antibodies play an important role in reperfusion failure during thrombolytic therapy with streptokinase in acute myocardial infarction. Therefore, the determination of streptokinase antibodies may differentiate between those patients who may benefit from streptokinase treatment and those who should be treated with some other regime.     

Saruplase in myocardial infarction

Saruplase is an unglucosylated single-chain recombinant urokinase-type plasminogen activator. Dose finding studies in patients with acute myocardial infarction indicated that a dose of 80 mg of saruplase, given as a bolus of 20 mg and iv infusion of 60 mg in one hour, led to excellent patency figures.Saruplase is most effective when combined with a bolus of 5000 IU heparin followed by an iv heparin infusion for at least 24 hours.When saruplase is compared to other thrombolytic agents (streptokinase, alteplase, urokinase), it becomes apparent that its profile is excellent. Early patency rates are at least comparable to alteplase. Further reocclusion rates of saruplase after one day are lower than those of streptokinase and alteplase. Patency rates 24–72 hours after start of medication are comparable between saruplase and urokinase.The large database in over 6000 patients shows that saruplase, in comparison to the other thrombolytic agents, is safe. Its bleeding complication rate is significantly lower than streptokinase, and a trend to lower in-hospital mortality is observed when compared to urokinase.Summarizing, when comparing to the presently available thrombolytic agents, saruplase is a fast acting, effective and safe thrombolytic agent.     

血浆D-二聚体和纤维蛋白原改变在肺癌中的临床意义

目的探讨肺癌患者血浆D-二聚体和纤维蛋白原水平的变化及临床意义。方法测定80例肺癌患者（肺癌组）及46例健康体验者（对照组）血浆D-二聚体、纤维蛋白原水平并进行对比分析。结果肺癌组血浆D-二聚体、纤维蛋白原水平高于对照组（P〈0.05）。肺癌组血浆D-二聚体、纤维蛋白原与病理类型、TNM分期之间无明显关系。治疗缓解组较初治组和复发难治组纤维蛋白原和D-二聚体水平均有下降（P〈0.05）。结论检测肺癌患者血浆D-二聚体及纤维蛋白原水平,可用作判断其体内高凝和纤溶状态,预测其血栓发生的危险程度,估计病情发展状况的依据。     

Efficacy and safety of low-dose streptokinase plus desmopressin in acute myocardial infarction: A pilot study

In this pilot study the combined use of desmopressin, which releases tissue plasminogen activator from vascular endothelium, and a low dose of streptokinase as a new thrombolytic regimen for acute myocardial infarction is proposed. Eighteen patients with acute myocardial infarction were treated intravenously with 150,000 U (4 patients) or 250,000 U (14 patients) of streptokinase infused over 10 minutes, followed by 24 g of desmopressin infused over 5–10 minutes. Aspirin and beta-blockers were administered at admission, and heparin and oral anticoagulants were started at the end of the thrombolytic regimen. Hemostatic parameters were studied before and 30, 60, 120, and 240 minutes after starting thrombolytic therapy. Fifteen patients (83.3%) had evidence of clinical reperfusion. Angiography was performed with a mean delay of 8.8 hours (range 1.5–22 hours) from the start of thrombolytic therapy. Fourteen patients (77.8%) had patency of the infarct-related artery: 10 patients (55.6%) achieved TIMI grade 3, and 4 patients (22%) achieved TIMI grade 2. Two patients (one TIMI grade 1 and one TIMI grade 2) underwent coronary angioplasty. No patient died during the in-hospital period. At 18 months follow-up, all patients are alive. No major or minor bleeding was detected. The significant decline in plasma fibrinogen and in the euglobulin lysis time, and the increase in fibrinogen/fibrin degradation products, indicate a plasma lytic state. Crosslinked fibrin degradation products increased from 310±120 ng/ml to 670 ±310 ng/ml (p=0.009), suggesting that fibrin digestion occurred in vivo. This pilot study provides data supporting the feasibility and efficacy of a new and more economic thrombolytic treatment of acute myocardial infarction without hemorrhagic complications.     

Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study.

AIMS: To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS: A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION: Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.     

溶栓治疗老年人急性心肌梗死34例分析

目的观察老年人急性心肌梗死（ＡＭＩ）溶栓治疗的安全性和有效性。方法７１例７０岁以上老年ＡＭＩ患者分成溶栓组（３４例）和对照组（３７例），比较其临床结果。结果（１）梗死相关动脉（ＩＲＡ）的再通率溶栓组显著高于对照组（６１．８％及１３．５％，Ｐ＜０．０１）；（２）溶栓明显改善了老年ＡＭＩ患者的左室射血分数（６３％及５２％，Ｐ＜０．０５）；（３）溶栓显著降低了老年ＡＭＩ患者的住院病死率（３５．１％对１４．７％，Ｐ＜０．０５），降幅为２０．４％；（４）溶栓组发生出血并发症６例（皮肤淤斑４例，上消化道出血２例），无严重出血（无需输血）并发症及脑卒中发生。结论对无禁忌证的老年人ＡＭＩ进行溶栓治疗，可以增加其血管再通率、改善心功能及降低病死率。     

Cost effectiveness of thrombolytic treatment for myocardial infarction: comparison of anistreplase, alteplase and streptokinase in 270 patients treated within 4 hours

Two hundred and seventy patients, under 71 years of age andsuffering from a less than 4 h infarction diagnosed accordingto clinical and electrocardiographic criteria, were included.two 90-patient groups were randomized and then treated witheither anistreplase (30 mg iv over 5 min) or alteplase (10 mgbolus injection + 5000 IU heparin bolus injection, followedby 90 mg alteplase over 3 h), and compared with a consecutivecontrol series of 90 patients treated with streptokinase (1.5million U over 1 h). Intravenous heparin and aspirin (250 mgday^–1) were then prescribed routinely. The three groupswere comparable as regards age (55.2±10 years), male/femaleratio (10.4 the site of the infarction (42% anterior, 55% inferior)and initial clinical seriousness (Killip I=90%, II=8%, III=2%).The patients were thombolysed in 17 community hospitals, andthen referred to a university hospital with catheterizationfacilities. An efficacy score was determined, based on fourparameters: two obtained from coronary angiography and leftventriculography performed on day 6±2 (N = 252) (asynergicscore and patency of the infarct-related artery), one from Tl-tomographyperformed at rest (infarct size) and one from radionuclide angiography(global left ventricular ejection fraction) performed betweenday 15 and day 21 (N = 242). The score (range: 0–24 perpatient) was 17.8±6.4 for alteplase, 17.7±6.0for anistreplase and 18.1±6.0 for streptokinase respectively(NS). The real cost of the hospital phase, for each patient,was determined by adding up the cost of thrombolytic treatment(ranging from 1.7% of the total hospital cost for streptokinaseto 16% for alteplase), other treatment and biological examinations(10% of the total cost), coronary angiography, followed in 35%of patients by angioplasty (21% of the overall cost) and hospitalization(ranging from 49% of the total cost for alteplase and anistreplaseto 56% for streptokinase [NS] for an average 17-day hospitalization.Thus, the total cost of the hospital phase was 6460 ECU foralteplase, 6570 ECU for anistreplase and 6050 ECU for streptokinase(NS). The cost/efficacy ratio was 548 ECU for alteplase, 570ECU for anistreplase and 405 ECU for streptokinase. Secondarymortality and re-infarction rates were very low (1.2% and 1.5%respectively) after 1 year following the treatment. However,ischaemia recurred in 23% of patients, requiring revascularizationoperations in 9% of them. Sixty-nine per cent of patients withprofessional occupations were able to resume these activities. This study showed no difference in efficacy between the threethrombolytic agents for the three left ventricular parameters(left ventricular ejection fraction, asynergic score, necroticmass) and for the patency of the infarct-related artery, andalso demonstrated that the cost of the thrombolytic agent hadrelatively little effect on the total cost of myocardial infarction.There could be a potential saving by shortening hospitalization,which accounted for half the cost of thrombolysed myocardialinfarction.     

Magnesium therapy for acute myocardial infarction

The use of magnesium therapy for acute myocardial infarction remains controversial despite recent clinical trials such as ISIS-4. Magnesium has numerous beneficial effects in the setting of myocardial infarction, including inhibitory effects on platelet aggregation. Clinical trials of magnesium therapy for myocardial infarction have yielded conflicting results that may be related to the difference in the timing of magnesium administration. Moreover, magnesium may have salutary effects in patients who are ineligible for thrombolytic therapy. Further clinical trials are still needed to elucidate definitively the role of magnesium therapy for myocardial infarction.     

Randomized comparison of enoxaparin with unfractionated heparin following fibrinolytic therapy for acute myocardial infarction.

AIMS: To compare the efficacy and safety of low molecular weight heparin with unfractionated heparin following fibrinolytic therapy for acute myocardial infarction. METHODS AND RESULTS: Three-hundred patients receiving fibrinolytic therapy following acute myocardial infarction were randomly assigned to low molecular weight heparin as enoxaparin (40 mg intravenous bolus, then 40 mg subcutaneously every 8 h, n=149) or unfractionated heparin (5000 U intravenous bolus, then 30 000 U. 24 h(-1), adjusted to an activated partial thromboplastin time 2-2.5x normal, n=151) for 4 days in conjunction with routine therapy. Clinical and therapeutic variables were analysed, in addition to use of enoxaparin or unfractionated heparin, to determine independent predictors of the 90-day composite triple end-point (death, non-fatal reinfarction, or readmission with unstable angina). The triple end-point occurred more frequently in patients receiving unfractionated heparin rather than enoxaparin (36% vs. 26%; P=0.04). Logistic regression modelling of baseline and clinical variables identified the only independent risk factors for recurrent events as left ventricular failure, hypertension, and use of unfractionated heparin rather than enoxaparin. There was no difference in major haemorrhage between those receiving enoxaparin (3%) and unfractionated heparin (4%). CONCLUSION: Use of enoxaparin compared with unfractionated heparin in patients receiving fibrinolytic therapy for acute myocardial infarction was associated with fewer recurrent cardiac events at 90 days. This benefit was independent of other important clinical and therapeutic factors.     

D-二聚体、纤维蛋白原与肺癌的分期及预后的关系研究

目的分析血浆D-二聚体、纤维蛋白原（fibrinogen,FIB）与肺癌的分期、体力状况评分及预后的关系。方法按分期、有无胸水及远处转移、卡氏及ECOG评分、死亡与否对肺癌患者进行分组,分别测定血浆D-二聚体、FIB水平,分析其在不同分组间的差异。结果 D-二聚体水平在以上不同分组间比较均差异显著。FIB水平在死亡组、存活组及不同卡氏及ECOG评分组间比较差异显著,而在其他分组间比较差异均无统计学意义。结论肺癌患者血浆D-二聚体、FIB水平均与预后相关。D-二聚体是比FIB更敏感的反映肺癌高凝状态的指标。     

Improved long term prognosis after myocardial infarction 1984-1991

Aims We set out to examine whether long term prognosis in termsof 2-year mortality after myocardial infarction has improvedafter the introduction of intravenous beta-blockers, nitroglycerininfusion, aspirin and thrombolytics, in an unselected populationof patients hospitalized with a myocardial infarction. Methods and Results We investigated retrospectively 3791 acutemyocardial infarctions in 3187 Göteborg women and men (1039women and 2148 men), who were consecutively admitted to thecoronary care unit at the Östra hospital during 1984–1991.Throughout this period, data were entered continuously intothe coronary care unit database. Mortality data were collectedthrough the Swedish cause-specific mortality register. The primaryend-point was mortality within 2 years after the onset of theindex infarction. Two-year mortality decreased from 36% in 1984to 25% in 1991. In a Cox regression model (including myocardialinfarctions up to 1993) year of hospitalization, age, diabetesmellitus, sex, prior myocardial infarction and indeterminableinfarct location all had a significant impact on survival aftermyocardial infarct. Thrombolytic therapy and hypertension hadno prognostic significance. Conclusion Against a background of radical changes in the treatmentof acute myocardial infarction during 1984– 1991 we haveseen decreasing in-hospital mortality as well as a substantialdecrease in 2-year mortality.     

急性心肌梗死患者链激酶加速溶栓疗法的多中心临床试验

目的 观察链激酶（ＳＫ）加速溶栓疗法治疗急性心肌梗死（ＡＭＩ）能否提高疗效的可能性恶性循环 。方法 由全国５０家系统组成协作组自１９９６年４月１日至１９９７年７月６日采用ＳＫ加速溶栓疗法（１５０万Ｕ,３０ｍｉｎ,内静脉滴入）治疗ＡＭ患共５２８例,观察临床疗效、不良反应及病死率。结果 ５周总病死率为６．６％（３５／５２８）,闭塞相关血管临床再灌注率为７９．７８％（４１２／５２８）,出血发生率为２．     

心肌梗塞患者血浆脑钠素N端前体肽与内皮素含量的相关性

目的:测定急性心肌梗塞(AMI)患者血浆脑钠素N端前体肽(Nt-proBNP-76),内皮素(ET)的含量,研究其临床意义。方法:用放射免疫法(RIA)分别测定46例AMI患者及20例健康人血浆中Nt-proBNP,ET含量并分析其相关性。结果:(1)AMI患者的血浆Nt-proBNP和ET含量均明显高于健康对照组(P依次为<0.001,<0.01);(2)AMI患者血浆Nt-proBNP与ET水平呈正相关(r=0.508,P<0.01)。结论:急性心肌梗塞患者血浆Nt-proBNP水平明显升高,并与ET水平呈正相关。提示Nt-proBNP,ET在AMI的发生、发展中起重要作用。联合测定的二者可作为心肌损伤坏死程度的预测指标。