早期血脑钠肽水平对首次急性心肌梗死后近期左室重构的预测价值

目的探讨早期血浆脑钠肽（BNP）水平对首次急性心肌梗死后近期左室重构的预测价值。方法86例首次急性心肌梗死（ST段抬高62例，非ST段抬高24例）患者于持续胸痛后准24h测定血浆BNP水平，于发病后24～72h、1月行超声心动图检查，在左心室长轴切面测量左室舒张末容量（LVEDV）、左室收缩末容量（LVESV）、左室射血分数（LVEF），计算左室舒张末容量指数（LVEDVI）、左室收缩末容量指数（LVESVI）、左室质量（LVM），并获得1月的变量值。根据1月左室舒张末容量指数变化幅度，分为轻度重构组（A组）、中度重构组（B组）、重度重构组（C组）和非重构组（D组），并分析4组持续胸痛后准24h血浆BNP水平与LVEDV、LVESV、LVEF、LVEDVI、LVESVI、LVM变量值的相关性。另设正常对照组30例。结果（1）首次急性心梗后1月时A组、B组、C组、D组血浆BNP水平分别为（214．86±64．92）ng／L、（46323±265．97）ng／L、（874．53±58446）ng／L、（118．03±51．65）ng／L。各组间及与对照组相比差别均有显著性的意义（P〈005）；（2）首次急性心梗后不同重构组早期BNP血浆水平均与1月LVESV、LVEDV、LVESVI、LVEDVI的变量值呈正相关，与LVEF变量值呈负相关，与LVM变量值无关；（3）首次急性心梗后1月时轻度、中度、重度重构组问的早期血浆BNP水平的参考截断点是246．5ng／L、449．0ng／L、856．0ng／L。结论早期BNP水平与首次急性心肌梗死后1月左室重构的程度密切相关，并有分层预测价值，早期BNP水平越高，左室重构程度越大。

Predictive value of early brain natriuretic peptide on left ventricular remodeling after first acute myocardial infarction

Objective To investigate the predictive value of early plasma brain natriuretic peptide （BNP） levels in patients with left ventricular remodeling after first acute myocardial infarction. Methods Eighty six patients with acute myocardial infarction （AMI） were recruited in the study, including 62 cases with ST segment elevation （STE） and 24 with non-ST segment elevation （NSTE）. Plasma BNP concentrations were measured with immunoradiometric assay at 24 hours after AMI. LVEDV, LVESV, LVEF, LVEDVI, LVESVI and LVM were measured by Doppler echocardiography at 24 hours and 1 month after AMI. According to the variable of LVEDVI, patients were divided into 4 groups： mild remodeling （group A）, moderate remodeling （group B）, heavy remodeling （group C） and non- remodeling （group D）. The correlation of early plasma BNP concentrations with variables of LVEDVI, LVEDV, LVESVI, LVESV, LVEFand LVM was analyzed. Results The plasmaBNPconcentrationswere（214.86±64.92） rig/L, （463.23± 265.97） rig/L, （874.53 ± 584.46） ng/L, （118.03 ± 51.65） ng/L in group A, group B, group C and group D at 1 month after AMI respectively, which were all significantly different with those of controls. Early plasma BNP levels were positively correlated with LVEDVI, LVEDV, LVESVI and LVESV and negatively correlated with LVEF; but not correlated with LVM. The reference cut-off point was 246.5 ng/L, 449.0 ng/L and 856.0 ng/L in group A, group B and group C respectively. Conclusion Early plasma BNP levels are correlated with the degree of left ventricular remodeling in AMI patients at 1 month after onset.