瑞替普酶与PCI治疗对急性ST段抬高型心肌梗死患者NT-proBNP及心室功能的影响

目的探讨急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者接受经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗和瑞替普酶溶栓治疗后对左心室功能与氨基末端脑钠肽前体（N—terminal pro—brain natriuretic peptide，NT-proBNP）的影响。方法选择STEMI再灌注治疗成功的患者共60例，随机（电脑随机数字表法）分为PCI治疗组30例，瑞替普酶组30例，两组均于人院即刻、12h、24h、72h以及7d测定血浆NT—proBNP浓度，采用多普勒超声诊断仪测量治疗后3d、6个月的左心室舒张末内径（LVEDD），左心室收缩末内径（LVESD），左心室射血分数（LVEF）。结果急诊PCI治疗组患者血浆NT—proBNP浓度较瑞替普酶组明显下降，差异有统计学意义（P〈0．05）。治疗6个月后，急诊PCI治疗组左心室舒张末内径、左心室收缩末内径、左心室射血分数较瑞替普酶组改善更为明显，差异有统计学意义（P〈0．05）。结论急诊PCI治疗和瑞替普酶治疗均能降低心肌梗死患者血浆NT—proBNP浓度，提高左心室射血分数，改善心室功能，但急诊PCI治疗效果更为明显。

Effects of reteplase thrombolytic therapy and PCI on NT-proBNP and ventricular function in patients with acute STEMI

Objectives To study the effects of reteplase thrombolytic therapy and percutaneous coronary intervention （PCI） on N-terminal pro-brain natriuretic peptide （NT-proBNP） concentrations and left ventricular function in patients with ST- segment elevation myocardial infarction. Methods The study included 60 patients with STEMI, and they were randomly divided into PCI group （n=30） and reteplase therapy group （n=30）. Plasma NT-proBNP concentrations were examined at admission, 12 h, 24 h, 72 h and 7 days in both groups. Parameters of left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left ventricular ejection fraction （LVEF） were assessed by echocardiography in both groups 3 days and 6 months after treatment. Results The plasma NT-proBNP concentrations were significantly lower in PCI group than that in reteplase therapy group （P〈0.05）. Six months after treatment, LVEDD, LVESD and LVEF in PCI group obviously improved compared with those in reteplase therapy group （P〈0.05）. Conclusions PCI and reteplase therapy can decrease plasma NT-proBNP concentrations and raise LVEF to improve ventricular function in patients with STEMI. The effect of PCI is better than that of reteplase.