B型钠尿肽对心肌梗死患者心功能评估的研究

目的观察急性心肌梗死（AMI）患者血B型钠尿肽（BNP）水平的变化特点，探讨BNP对评估AMI患者心力衰竭及心肌缺血严重程度的临床意义。方法入选住院AMI患者93例及正常对照组50例进行BNP的床旁快速检测，并行超声心动图测定左心室射血分数（LVEF）和左心室舒张末期内径（LVEDd），按照心肌梗死Killip心功能分级分为Ⅰ—Ⅳ级，按照梗死部位分为广泛前壁AMI组、前壁和／或前间壁AMI组、下壁和／或后壁AMI组，根据ST段有无抬高分为ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI），计算各组内的BNP值并进行统计学分析。结果随着AMI患者Killip心功能分级的递增，BNP水平不断增高（除KillipⅠ级与对照组BNP浓度比较P〉0．05，其余各组之间BNP差异有统计学意义P〈0．05），LVEF随着Killip分级递增而减少，与BNP呈中度负相关（r=-0．79，P〈0．05）而LVEDd逐渐增大与BNP呈高度正相关（r=0．96，P〈0．05）。广泛前壁AMI组BNP浓度〉前壁和／或前间壁AMI组〉下壁和／或后壁AMI组。STEMI组和非NSTEMI组BNP水平差异无统计学意义。结论床旁快速测定BNP浓度可作为判定AMI患者心功能状况及心肌缺血严重程度的重要生化指标之一。

Significance of B-type natriuretic peptide in evaluating ventricular function in patients with acute myocardial in-farction

Objective To evaluate the value of B-type natriuretic peptide （BNP） in estimating the severity of heart failure and myocardial ischemia in patients with acute myocardial infarction （AMI）. Methods 93 patients with AMI and 50 healthy subjects were selected into the study. Plasma concentrations of BNP were measured in AMI patients and healthy controls. Left ventricular function was evaluated by echocardiography with respect to left ventricular ejection function （LVEF） and left ventricular end-diastolic diameter （LVEDd）. According to killip classification, AMI patients were divided into ST elevation myocardial infarction （STEMI） and non- ST elevation myocardial infarction （NSTEMI） group on the basis of the location of infarction and coronary arteries involved. Results With the upgrading of killip classofocation, the concentration of BNP and LVEDd in AMI patients increased gradually while LVEF decreased gradually. Plasma BNP was significantly and positively correlated with LVEDd and severity of the ventricular function （r = 0.96, P〈0.05）, and negatively correlated with LVEF （r = -0.79, P〈0.05）. BNP level in acute wide-anterior myocardial infarction was significantly higher than that in acute inferior wall myocardial infarction. BNP level in STEMI was similar to that in NSTEMI. Condution The plasma concentration of BNP in AMI patients might be an important biochemical marker for assessing the severity of heart failure and myocardial ischemia.