急性心肌梗死患者血B-型尿钠肽水平的变化特点

目的观察急性心肌梗死(AMI)后血B-型尿钠肽(BNP)水平升高的特点,探讨AMI后BNP水平升高的意义。方法连续入选住院AMI患者230例及正常对照111例进行BNP测定。按照首次或再发AMI后ST段抬高型或非ST段抬高型AMI(STEMI或NSTEMI)、不同部位AMI、不同冠状动脉病变、不同梗死相关血管(IRA)、IRA不同TIMI血流和是否急诊经皮冠状动脉介入治疗(PCI)进行分组,采用Student-t检验和ANOVA分析对比各组间BNP水平和心功能相关指标的差异。结果AMI后2~7天,患者BNP水平显著升高(P<0.01),平均为(553.7±735.1)ng/L,是对照组的21倍;与首次AMI组对比,再发组左室射血分数(LVEF)显著降低(P<0.01),左室舒张末径(LVEDd)、BNP水平和LnBNP均显著升高(P均<0.01);与无显著狭窄病变AMI患者对比,单支、三支血管狭窄组的BNP水平显著为高(P均<0.05);IRA的TIMI血流0~1、2级组BNP水平均显著高于TIMI血流3级组(P均<0.01);与未急诊PCI组对比,急诊PCI组血肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)虽显著升高(P<0.05~0.01),然BNP水平显著降低(P<0.05)。结论AMI后,血BNP水平显著升高。以再发AMI、未行急诊PCI治疗和IRA血流TIMI0~2级者更高。急诊PCI可出现心肌酶升高,而BNP降低的矛盾现象。

Serum B-type natriuretic peptide changes in patients with acute myocardial infarction

OBJECTIVE: To observe the serum B-type natriuretic peptide (BNP) changes post acute myocardial infarction (AMI). METHODS: The serum BNP level was determined in 230 consecutive patients with AMI admitted to CCU and in 111 normal cases from October 2002 to October 2003 in Fuwai Hospital. The 230 AMI patients were further divided into various subgroups according to first or recurrent AMI, ST elevations myocardial infarction (STEMI) or non-ST elevations myocardial infarction (NSTEMI) group, infarction location, coronary arteries involved, infarction related arteries (IRA), TIMI blood flow of IRA and primary PCI or not. Serum BNP, CK-MB, TnT and heart function were analyzed. RESULTS: The serum BNP level was significantly increased in patients with AMI (553.7 +/- 735.1) ng/L than that in normal subjects [(26.4 +/- 27.4) ng/L, P < 0.05]. LVEF was significantly lower, and LVEDd, BNP and LnBNP were all significantly higher in the first time AMI group compared to recurrent AMI group (all P < 0.001). The BNP level were significantly higher in AMI patients with single or triple coronary arteries stenosis than those without coronary stenosis (P < 0.05), in TIMI blood flow 0 - 1 and 2 groups than in TIMI 3 group (all P < 0.001). The CK-MB and TnT were significantly increased while BNP significantly decreased in the patients underwent primary PCI group compared with patients did not receive PCI therapy (all P < 0.05 - 0.001). CONCLUSION: Serum BNP was significantly elevated in patients after AMI but decreased after successful primary PCI in patients with AMI.