同型半胱氨酸、N-末端脑钠肽前体与急性心肌梗死后左心室重构的关系

目的 探讨急性心肌梗死（acute myocardical infarction,AMI）患者同型半胱氨酸（homocysteine,Hcy）、N-末端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）浓度对心肌梗死后左心室重构的预测价值及对AMI患者临床预后的影响.方法 选择2009年6月至2011年6月在广州市第一人民医院心内科住院并诊断为急性ST段抬高型心肌梗死（STEMI）的患者266例,根据入院后空腹Hcy浓度的三分位数间距将患者分为A组（Hcy＜15.6μmol/L）83例,B组（15.6～24.6 μmol/L）组93例和C组（Hcy＞24.6μmol/L）90例.测定患者入院时即刻NT-proBNP浓度,并于入院48 h内及半年后行超声心动图测定患者左心室舒张末期内径（LVEDd）、左心室舒张末期容积（LVEDV）,左心室收缩末期容积（LVESV）,左心室射血分数（LVEF）.动态追踪观察3组患者随访期间内（6个月）的主要心血管事件（MACE）的发生情况.结果 三组患者随Hcy浓度升高,NT-proBNP浓度升高,左心室舒张末期容积和左心室收缩末期容积显著增加,左心室射血分数降低（P＜0.05 or P＜0.01）.ST段抬高型心肌梗死患者Hcy与NT-proBNP浓度呈正相关（r=0.380,P＜0.05）.直接经皮冠状动脉介入治疗随访6个月,Kaplan-Meier生存分析发现三组患者累积无主要心血管事件生存率比较,差异有统计学意义（91.6％ vs.86.0％ vs.77.8％,Log rank=6.630,P=0.036）.多因素Logistic回归分析显示Hcy、NT-proBNP均是ST段抬高型心肌梗死患者近期主要心血管事件发生的独立预测因子.结论 AMI患者Hcy、NT-proBNP浓度与梗死后心室重构密切相关,Hcy、NT-proBNP对患者的近期预后具有预测意义.

Relationships between homocysteine,N-terminal pro-brain natriuretic peptide and left ventricular remodeling in patients with acute myocardial infarction

Objectives To investigate the predicting value of homocysteine （Hcy） and N-terminal pro-brain natriuretic peptide （NT-proBNP）in left ventricular remodeling and the prognosis of patients with acute myocardial infarction.Methods Totally 266 patients with ST-elevation myocardial infarction（STEMI） who were diagnosed as STEMI from June 2009 to June 2011 in Guangzhou First People＇ s Hospital were enrolled and followed-up.Patients were divided into 3 groups according to their Hcy levels at admission：Group A （Hey 〈 15.6 μmol/L,n =83）,Group B （15.6-24.6 μmol/L,n =93）and Group C （Hcy 〉24.6 μmol/L,n =90）.NT-proBNP levels of patients at admission were measured and echocardiography examination was administered in 48 h after admission and 6 months later to identify left ventricular end-diastolic dimension （LVEDd）,left ventricular end-diastolic volume （LVEDV）,left ventricular end-systolic volume （LVESV） and left ventricular ejection fraction （LVEF）.Major cardiac adverse events （MACE） of patients in the 3 groups during follow-up were recorded.Results LVEDV and LVESV increased,while LVEF decreased（P〈0.05 or P〈0.01） as Hcy level and NT-proBNP level increased.In patients with STEMI,Hcy level was positively related to NT-proBNP level（r=0.380,P〈0.05）.After 6 months of follow-up,Kaplan-Meier survival analysis showed that cumulative non-events survival rates were significantly different among the 3 groups （91.6% vs.86.0% vs.77.8%,Log rank=6.630,P=0.036）.Binary Logistic regression analysis indicated that both Hcy and NT-proBNP were strong independent predictors for recent prognosis of patients with STEMI.Conclusions Hcy and NT-proBNP are associated with left ventricular remodeling in patients with AMI.They are valuable in predicting recent prognosis of patients with AMI.