急性心肌梗死直接PCI术后NT-proBNP与左室重构的变化

目的 探讨急性ST段抬高型广泛前壁心肌梗死(STAMI)直接经皮冠状动脉介入术(PCI)前后血浆N氨基酸末端脑钠肽前体(NT-proBNP)与左室重构(LVRM)的变化.方法 72例急性心肌梗死患者入院分为常规药物治疗组35例和常规药物加急诊PCI术组37例,于入院24 h内或急诊直接经皮冠状动脉介入术(PCI)前及入院第10 d检测血浆NT-proBNP,入院时及第9～10 d行超声心动图测定左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(Fs)及左室舒张末期容积(LVEDV),分析血浆NT-proBNP变化与左室形态与功能变化的关系.结果 药物组与药物加直接PCI组治疗后与治疗前比较血浆NT-proBNP明显下降,LVEF、FS值增高,P<0.05,LVEDD、LVEDV均较治疗前增加,P>0.05.PCI组与药物治疗组比较治疗前血浆NT-oroBNP、LVEF、FS、LVEDD、LVEDV均无明显差异,P>0.05.PCI组较药物组治疗后血浆NT-oroBNP明显下降,LVEF、FS明显增高,P<0.05,LVEDD、LVEDV下降,P>0.05.结论 急性ST段抬高型心肌梗死早期(发病24-48 h)血浆NT-proBNP增高可反映左室重构的变化,而早期直接PCI术可明显降低血浆NT-proBNP,改善左室收缩功能,并可降低左室重构的发生.

Changes of Plasma NT-proBNP and Left Ventricular Remodeling in Patients with Acute myocardial infarction afterPCI

Objective To explore the relationship between the changes of plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)and left ventricular remodeling(LVRM)in early acute myocardial infarction(AMI)patients before and after PCI.Methods Seventy-two patients admitted to our hospital with AMI were randomly divided into two groups,35 were in medicine treated group(M-group)and another 37 were in the medicine plus emergent PCI group(PCI-group).The plasma NT-proBNP was measured within 24 hours after admission or before PCI and on the 10 th day after admission,and echocardiogram were performed for all of the patients at admission and on the 9th or 10th day after admission to evaluate the left ventricular remolding by measuring the left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),left ventricular shortening(FS)and left ventricular end-diastolic volume(LVEDV)to analyze the relationship between the NT-proBNP and the morphology and function of the left ventricle.Results The levels of plasma NT-proBNP decreased,LVEF and FS increased after the treatment in both of the two groups than that before treatment significantly(P<0.05),and no significant difference were observed for LVEDD and LVEDV(P>0.05).No significant difference was observed for the plasma NT-proBNP,LVEF,FS,LVEDD,LVEDV between the two groups before the treatment(P>0.05).The levels of plasma NT-proBNP decreased and LVEF,FS increased significantly after the different treatment in PCI-group than that of M-group(P<0.05),but LVEDD,LVEDV decreased insignificantly(P>0.05).Conclusions The increased plasma NT-proBNP in AMI patients may reflect the left ventricular remodeling.PCI may decrease significantly the plasma NT-proBNP,imorove the left ventricular function and reduce the incidence of left ventricular remodeling.