急性心肌梗死患者血浆脑钠肽与心肌再灌注水平的关系探讨

目的探讨急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌再灌注水平对血浆脑钠肽(BNP)的影响。方法连续入选86例成功接受急诊PCI术的AMI患者,根据心肌Blush分级分为0+1级组(n=26)、2级组(n=32)和3级组(n=28)。于PCI术前及术后24h、48h、14d测定血浆BNP浓度,14d时行超声心动图检查测定左室舒张末容积指数(LVEDVI)、左室收缩末容积指数(LVESVI)和左室射血分数(LVEF),并进行组间比较。结果血浆BNP水平PCI术前无明显差异,术后24h、48h和14d时Blush0+1级组>Blush2级组>Blush3级组,24h时分别为(631±285)ng/L、(362±149)ng/L和(278±135)ng/L(P<0.05);48h时:(482±246)ng/L、(278±112)ng/L和(205±124)ng/L(P<0.05);14d时:(257±133)ng/L、(163±78)ng/L和(119±50)ng/L(P<0.05)。14d时BNP水平与LVEDVI(r=0.75,P<0.01)、LVESVI(r=0.78,P<0.01)呈正相关,与LVEF(r=-0.63,P<0.01)呈负相关。结论急诊PCI后心肌再灌注水平显著影响AMI患者血浆BNP水平和心功能。

Relationship between brain natriuretic peptide in plasma and the extent of myocardial reperfusion in patients with acute myocardial infarction

Objective To explore the influence of different content of myocardial repeffusion on the plasma brain natriuretie peptide（BNP） in patients with acute myocardial infarction（AMI） underwent successful treatment of percutaneous coronary intervention（PCI）.Methods Consecutive 86 AMl patients treated with PCl were involved divided into grade 0 ＋ 1 group（ n = 26）, grade 2 group（ n = 32） and grade 3 group（ n = 28）, according to myocardial Blush classification.Plasma BNP levels were examined by fluoroimmunoassay before PCl and 24 h,48 h and 14 d after PCI,and left ventricular end diastolic volume index（ LVEDVI）, left ventricular end systolic volume index （LVESVI） and left ventricular ejection fraction（LVEF） were measured with echocardiograpby at 14 d post PCI.Results There was no significant statistical difference in 3 groups of BNP before PCI. The BNP level in grade 1, grade 2, grade 3 group were （631±285）ng/L,（362 ±149）ng/L and （278±135）ng/L in 24 h post PCI（ P 〈 0.05）,（482±246）ng/ L,（278±112）ng/L and（205±124） ng/L in48 h post PCI（ P 〈 0.05）, （257±133）ng/L, （163±78）ng/L and （ 119±50 ）ng/L respectively in 14 d post PCI（ P 〈 0.05）. The value of plasma BNP was significantly positively correlated with LVEDVI（ r =0.75, P 〈 0.01）and LVESVI（ r =0.78, P 〈0.01）, while negatively correlated with LVEF（ r = -0.63,P 〈0.01） at 14d pust PCI.Conclusion The eontent of myocardial reperfusion post emergency PCI has significant influence on plasma BNP and cardiac function in patients with AMI.