急性心肌梗死患者溶栓治疗后心电图早期T波倒置、BNP变化对左室重构的意义

目的观察急性心肌梗死患者接受静脉溶栓治疗后心电图T波倒置、血浆中BNP的水平变化与左室重构之间的关系,探讨T波倒置、BNP对左室重构的预测价值。方法首次急性心肌梗死患者共54例,溶栓治疗后持续24h监测心电图,A组(溶栓治疗后24小时出现T波倒置,n=38)与B组(溶栓治疗后24小时T波仍直立,n=16)于治疗前及治疗后第7天,采用电化学发光法对血浆BNP水平进行检测,并随访复查急性心肌梗死后2~3天及第3个月超声心动图。结果溶栓治疗后BNP水平,A组明显小于B组;A组内治疗前后BNP比较,治疗后明显减小;B组治疗后BNP水平明显增加。A组患者溶栓治疗后2~3天及3个月时LVEDD比较,差异无显著性;B组患者溶栓治疗后3个月时LVEDD明显增大,B组左室重构发生率明显高于A组。结论急性心肌梗死患者溶栓治疗后心电图早期T波倒置和BNP水平降低对于预测左室重构有重要意义。

The clinical importance to left ventricular remodeling of early T wave inversion and the change of BNP concentration in patients with acute myocardial infarction after thrombolysis therapy

Objective To investigate the outcome prediction of T wave,BNP to left ventricular remodeling(LVRM) by observing the relation of the changes of T wave in electrocardiograms and plasma BNP in cases with acute myocardial infarction(AMI) after thrombolysis with LVRM.Methods 54 patients with a first AMI treated with thrombolysis underwent 24 hours ECG monitoring from the onset of the symptoms.Group A: T wave inversion within 24 hours,n=38;Group B: the upright amplitude of T wave within 24 hours,n=16;plasma BNP levels was measured with eletrochemistry luminescent technique before thrombolysis and at 7th day after thrombolysis;and echocardiogram was checked at 2nd-3rd day and 3rd month after AMI.Results With thrombolysis,the plasma BNP levels in group A decreased significantly vs in group B;in group A,the plasma BNP levels after treatment decreased significantly vs before treatment;on the contrary in group B.In group A,there was no significant difference of LVEDD between at 2nd-3rd day and at 3rd month after thrombolysis;in group B,LVEDD at 3rd month after thrombolysis increased significantly vs that at 2nd-3rd day after thrombolisis;the rate of LVRM in group B was bigger than that in group A.Conclusion The early T wave inversion and the decreasion of the plasma BNP levels after thrombolysis of AMI is clinically important for predicting the LVRM.