急诊介入治疗对急性ST段抬高心肌梗死患者血浆氨基末端B型利钠肽前体的影响

目的 探讨急诊介入治疗对急性ST段抬高心肌梗死患者血浆氨基末端B型利钠肽前体(NT-proBNP)的影响及发病后7天NT-proBNP与心功能的关系.方法 连续入选60例急性ST段抬高心肌梗死患者,根据入院后治疗方式分为急诊介入组(45例)、药物治疗组(15例),其中急诊介入组又根据心肌梗死溶栓试验(TIMI)心肌灌注(TMP)分级分为心肌灌注良好组(35例)和心肌灌注不良组(10例),均入院后即刻、发病后24小时、发病后3天和7天取外周静脉血样测定NT-proBNP,同时各组在发病后7天测定左心室射血分数(LVEF),比较各组NT-proBNP数值的差别以及发病后7天NT-proBNP与LVEF的关系.结果 ①3组患者入院后即刻NT-proBNP水平差异无统计学意义(P>0.05).与入院后即刻比较,发病后24小时、3天、7天各时间点,各组NT-proBNP水平显著升高(均P<0.05);发病后24小时、3天、7天各时间点比较,心肌灌注良好组NT-proBNP水平显著低于心肌灌注不良组(598.3±216.5)ng/L vs(950.1±215.8)ng/L,(453.2±147.8)ng/L vs(1 439.8±325.7)ng/L,(332.6±125.1)ng/L vs(1 249.9±406.4)ng/L(均P<0.05),心肌灌注不良组NT-proBNP水平显著低于药物治疗组(均P<0.05).②发病后7天时NT-proBNP水平与LVEF呈负相关(r=-0.782,P<0.01).结论 在急性ST段抬高心肌梗死患者中,急性期NT-proBNP水平显著升高,急诊介入治疗可以显著降低其NT-proBNP水平;发病7天时NT-proBNP水平与心功能呈负相关,是心肌灌注成功的重要标志.

Effect of immergency percutaneous coronary intervention to NT-proBNP in patients with acute ST-elevation myocardial infarction

Objective To explore the effect of immergency percutaneous coronary intervention to plasma NT-proBNP in patients with acute ST-elevation myocardial infarction（STEMI） and the relation of the left ventricle function with the NT-proBNP at 7 days from the onset.Methods A total of 60 consecutive patients with STEMI were enrolled.The patients according to the treatment modes after admission were divided into three groups：Group 1（received medication,n=15）,Group 2（received successful reperfusion by TIMI myocardial perfusion grade,n=40）,Group 3（received unsuccessful reperfusion by TIMI myocardial perfusion grade,n=10）.Blood samples for NT-proBNP were drawn at admission,24 hours and 3,7 days from the onset respectively.Left ventricle ejection fraction（LVEF） was measured in all patients at 7 days from the onset.NT-proBNP among groups on 7th day after admission was compared and its correlation with LVEF was evaluated.Results ①No statistical differences were observed among three groups at admisson（P〈0.05）.All NT-proBNP level significantly increased at 24 hours and 3,7 days from the onset（all P〈0.05）.NT-proBNP level of successful reperfusion by TIMI myocardial perfusion grade was significantly lower than that of unsuccessful reperfusion at 24 hours,and 3,7 days from the onset（598.3±216.5） ng/L vs（950.1±215.8） ng/L;（453.2±147.8） ng/L vs（1 439.8±325.7） ng/L;（332.6±125.1） ng/L vs（1 249.9±406.4） ng/L（all P〈0.05）.②The NT-proBNP level at 7 days from the onset showed a significant negative correlation with LVEF（r=-0.782,P〈0.01）.Conclusion NT-proBNP significantly increases at acute phase in patients with acute ST-elevation myocadial infarction.Successful reperfusion by immergency percutaneous coronary intervention can suppress the rise of the levels of NT-proBNP in patients with acute STEMI.NT-pro BNP at 7 days from the onset showed a significant negative correlation with LVEF.