急性心肌梗死患者血浆脑钠肽水平变化与急性室壁瘤形成的关系

目的探讨急性心肌梗死(AMI)后,急性左心室室壁瘤(LVA)形成患者血浆脑钠肽(BNP)的动态变化及其与LVA形成和心功能状态的关系。方法首次前壁AMI患者64例,经左室造影(LVG)后分为LVA组(31例)和无LVA组(33例)。采血检测BNP,并于经皮冠状动脉介入治疗(PCI)完成后6个月时检测有创容积和压力各参数。结果LVA组AMI后6 h、第5天和第24周血浆BNP浓度均明显高于无LVA组(P<0.05)。PCI后即刻和术后6个月时,无LVA组左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、室壁运动积分(WMS)和左室舒张末期压(LVEDP)各参数均高于无LVA组。LVA组BNP峰值水平与PCI后即刻LVESVI、LVEDVI、WMS和LVEDP呈显著正相关(P<0.01),与LVEF呈显著负相关(P<0.01)。LVA组MACE发生率明显高于无LVA组患者(P<0.05),且BNP峰值水平与主要不良心脏事件发生率显著正相关(P<0.05)。结论AMI后BNP的过度分泌参与了AMI后左室重构和LVA的形成,并影响着其后的心室功能。

Relationship between change of plasma BNP level and acute ventricular aneurysm formation in patients with acute myocardial infarction

Objective To investigate the change of brain natriuretic peptide(BNP) in plasma and its relationship with the acute left ventricular aneurysm(LVA)formation and cardiac performance in acute myocardial infarction(AMI) patients.Methods A total of sixty four patients [51 male,13 female,age(64.8±12.2)years] with primary anterior AMI accompanied by LVA diagnosed by left ventriculography(LVG) were enrolled in this study and divided into LVA group(33 patients) and non-LVA group(31patients).Plasma BNP was measured after onset of the AMI.Immediately after PCI and at 6th month after AMI,the parameters of left ventricular end diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI),LVEF,wall motion score(WMS) and LVEDP were measured by LVG.The main adverse cardiac events(MACE)were recorded during 24 weeks after PCI.Results The peak value of plasma BNP in LVA group was higher than that in the non-LVA group(P<0.01).On 5th day and at 24th week after AMI,the plasme BNP level was higher and the time attaining peak values of plasma BNP was earlier in LVA group than those in non-LVA group(P<0.05,respectively).At 6th month after AMI,the parameters of LVEF,LVESVI,LVEDVI,WMS and LVEDP in non-LVA group were much higher than those in LVA group.The peak value of plasma BNP was positively correlated with LVESVI,LVEDVI,WMS and LVEDP in LVA group(P<0.01,respectively),and negatively correlated with LVEF immediately after PCI(P<0.01).During the 6 months follow-up,the incidence of MACE in LVA group was significantly higher than that in the non-LVA group(P<0.05).The peak value of plasma BNP in LVA group was positively correlated with the incidence of MACE(P<0.05).Conclusions It is indicated that the over secretion of BNP is involved in the left ventricular remodeling andthe process of LVAformation.