重组人脑利钠肽对冠心病患者择期PCI术后心肌损伤的影响

目的：探讨重组人脑利钠肽（ rhBNP）对冠心病患者择期经皮冠状动脉介入治疗（ PCI）术后心肌损伤的影响。方法选择行择期PCI治疗的冠心病患者210例，随机分为rhBNP组（ n ＝106）和对照组（ n ＝104）。2组患者基础治疗相同，rhBNP组于术前2 h应用rhBNP，首先以1贩．5μg／kg负荷剂量静脉注射，后以0．01μg· kg－1· min－1持续静脉泵入72 h。分别于术前、术后8 h、24 h及3 d测定2组患者血清肌酸激酶同工酶（ CK-MB ）、肌钙蛋白I （ cT-NI）、N-末端前脑利钠肽（NT-proBNP）及白介素-8（IL-8）水平。观察2组患者治疗前后血清CK-MB、cTNI、NT-proBNP和IL-8水平变化，比较2组患者术后心肌损伤发生率。结果2组术前血清CK-MB、cTNI、NT-proBNP、IL-8水平差异无统计学意义（ P ＞0．05）。 rhBNP组术后8 h2、4 h血清CK-MB峰值水平低于对照组（P ＜0．05），术后8 h、24 h及3 d血清cTNI峰值水平均明显低于对照组（ P ＜0．05）。2组术前血清NT-proBNP、IL-8水平变化，差异无统计学意义（ P ＞0．05）。 rhBNP组术后8h、24h和3d NT-proBNP、IL-8均明显低于对照组（ P ＜0．05）。 rhBNP治疗组PCI术后心肌损伤发生率明显低于对照组（ P ＜0．05）。结论冠心病择期PCI术前给予rhBNP可通过抑制交感神经-内分泌系统激活和影响炎症因子对PCI术后心肌损伤起到一定保护作用。

Effects of recombinant human brain natriuretic peptide on myocardial injury in patients with coronary heart disease after selective percutaneous coronary intervention

Objective To investigate the effects of recombinant human brain natriuretic peptide ( rhBNP ) on myocardial injury in patients with coronary heart disease ( CHD ) after selective percutaneous coronary intervention ( PCI ) . Methods Two hundred and ten patients with CHD were randomly divided into rhBNP group ( n =106 ) and control group (n=104).The patients in both groups were treated by basic treatment , however, the patients in rhBNP group were given rhBNP on 2 hours before PCI , firstly which was intravenously injected at 1.5μg/kg loading dose for 90s, then continuously intravenously infused at 0.01μg· kg-1· min-1 for 72h.The serum levels of creatine kinase-MB (CK-MB),creatine cardiac troponin I( cTNI) ,N-terminal pro brain natriuretic peptide ( NT-proBNP ) and interleukin-8 ( IL-8 ) were detected before PCI and on 8h,24h,3d after PCI for both groups .Moreover,the changes of CK-MB,cTNI,NT-proBNP,IL-8 and the incidences of postoperative myocardial injury were observed and compared between two groups .Results There were no significant differences in the serum levels of CK-MB,cTNI,NT-proBNP,IL-8 before PCI between two groups ( P >0.05).The levels of CK-MB on 8h,24h after PCI in rhBNP group were significantly lower than those in control group ( P <0.05),and the levels of cTNI on 8h,24h,3d after PCI in rhBNP group were significantly lower than those in control group ( P <0.05).There were no significant differences in the serum levels of NT-proBNP,IL-8 before PCI between two groups ( P >0.05).The levels of NT-proBNP,IL-8 on 8h,24h,3d after PCI in rhBNP group were significantly lower than those in control group ( P <0.05). The incidences of postoperative myocardial injury in rhBNP group were significantly lower than those in control group ( P <0.05).Conclusion The administration of rhBNP before selective PCI may have a certain protective effects on postoperative myocardial injury by inhibiting activation of the sympathetic nerve -endocrine system and influencing inflammatory factors .