B型钠尿肽对急性心肌梗死患者治疗及预后的评估

目的:通过分析急性心肌梗死患者保守及介入治疗(PCI)后B型钠尿肽(BNP)水平,探讨PCI对BNP水平的影响及BNP与近期预后的关系。方法:入选急性ST段抬高心肌梗死患者103例,依据入院后治疗方式分为6h内介入治疗40例(组1),6～12h介入治疗33例(组2),药物保守治疗30例(组3)。所有患者于入院即刻、发病48h及7d时从周围静脉中留取血样测定BNP,并于发病后1个月行超声心动检查,随访3个月后的心血管事件发生情况。结果:⑴3组在入院时基础BNP水平无显著差异(P>0.05),发病48h、7d时BNP水平组1较组2均显著下降(P<0.01,P<0.05);组1较组3也显著下降(P<0.05,P<0.01);组2与组3比较,7d时BNP水平前者显著下降(P<0.05)。⑵发病7d的BNP水平与1个月时的左室射血分数显著负相关、与Tei指数显著正相关。⑶发病3个月后发生心血管事件的患者BNP水平显著高于未发生者(P<0.01)。结论:在急性ST段抬高心梗患者中,发病7d时BNP水平与近期心功能显著相关,对近期心血管事件的发生有一定预测作用,早期介入治疗可以显著降低发病7d时BNP水平。

Evaluation of the prognosis and treatment in patients with acute myocardial infarction by B-type natriurefic peptide

Objective:To evaluate prognosis of patients with ST elevation myocardial infarction(STEMI) by B-type natriuretic peptide(BNP).Methods:One hundred and three consecutive patients with STEMI were enrolled.They were divided into 3 groups:Group 1(received PCI within 6 hours from the onset,n=40);Group 2(received PCI within 6-12 hours from the onset,n=33); Group 3(received consecutive medicine therapy,n=30).Blood samples for BNP were drawn at admission,48 hours and 7 days from the onset,respectively.All patients were followed at 1 month by echocardiography.Results:(1)BNP levels were significantly lower at 7 days from the onset in Group 1 and Group 2 than those in Group 3(P<0.05).(2) BNP levels at 7 days from the onset showed a significant negative correlation with left ventricular ejection fraction(LVEF)(r=-0.722,P<0.01) and a positive correlation with Tei index in 1 month(r=0.582,P<0.01).(3)Followed up for 3 months,BNP levels were significantly increased at 7 days from the onset in patients to whom cardiac events happened(P<0.01).Conclusion:Elevations in BNP at 7 days from the onset are associated with abnormal LVEF and adverse clinical outcome after STEMI.BNP levels was decreased in patients received early PCI.