首发急性ST段抬高性心肌梗死患者早期B型利钠肽水平与左室重构的关系

目的 探讨首发急性ST段抬高性心肌梗死患者心肌梗死发作24小时血浆B型利钠肽（BNP）水平与心肌梗死后6个月左窒重构的相关性.方法 选择首发急性ST段抬高性心肌梗死患者70例,发病后12小时之内均成功接受急诊经皮冠状动脉介入治疗.采用荧光测定法测定患者心梗急性发作24小时（早期）、第30天及6个月时血浆BNP水平;超声心动图测定左室舒张未期容积、左室收缩未期容积并计算左室射血分数.随访6个月,观察心梗后早期BNP水平与心梗后6个月左室重构的关系.结果 27%的患者发生了左室重构,左室重构组患者早期及随访30天、6个月血浆BNP水平均明显高于无左室重构组患者.在校正了年龄、高血压病、糖尿病、心梗部位、E峰减速时间及左室射血分数等影响左室重构的因素后,心梗后早期血浆BNP水平与心梗后6个月左室重构独立相关.结论 早期测定血浆BNP水平有助于评价首发急性ST段抬高性心肌梗死患者急诊冠脉介入术后左心室重构,对判断预后有一定价值.

Relation beween brain natriuretic peptide levels on admission for patients with first ST-elevation myocardial Infarction and left ventricular remodeling at 6-month follow-up

Objective To investigate the relation between brain natriuretic peptide（BNP） levels on the first 24 hours after ST-segment elevation acute myocardial infarction（STEMI） and the development of left ventricular remodeling at 6-month follow-up. Method Consecutive Seventy patients with first STE- MI,successfully reperfused by primary percutaneous coronary intervention（PCI） within 12 hours of symp- tom onset, were included in this study. BNP plasma concentration levels were measured by fluorescence immunoassay at 24 h from onset, and at 1-and 6-month follow-up. Left ventricular diastolic volume ,left ventricular systolic volume and left ejection fraction were assessed using echocardiography on the third day after the onset of STEMI and at 1-and 6-month follow-up, observe the relation between the left ventricular remodeling at 6-month follow-up and plasma BNP levels on admission. Result 27% of patients developed LV remodeling at 6-month follow-up. BNP levels on admission and at follow-up were significantly higher in patients who developed LV remodeling at 6 months. After adjusting for age, hypertension, diabetes, infarct location, E-wave deceleration time and the LV ejection fraction, BNP on admission independently correlated with LV remodeling（r = -0. 621 ,P = 0. 000）. Conclusion Determination of plasma BNP levels on admission can be helpful in evaluating the development of left ventricular remodeling for patients with fist STEMI underwent PCI.