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目的:观察急性心肌梗死(AMI)患者接受急诊经皮冠状动脉介入(PCI)治疗前后的脑利钠肽(BNP)水平变化及其与左室功能,心室重构的关系,探讨BNP在急诊PCI治疗AMI患者预后评估中的作用。方法:入选2008-06-2009-02,发病后12h内接受急诊PCI治疗的ST段抬高型急性心肌梗死(STEMI)患者120例,入院即时及出院时采用酶联免疫法测定患者血浆BNP水平,出院前行超声心动图检测左室射血分数,并根据PCI治疗后7d的BNP水平将患者分为3组:A组<100ng/L,B组为100～400ng/L,C组>400ng/L。所有患者术后6个月进行超声心动图检查,根据左室射血分数、左室舒张末期容积、左室收缩末期容积变化评估左室功能及心室重构。结果:BNP水平与AMI病变范围呈正相关,与左室射血分数呈负相关;PCI治疗后不同心肌梗死部位BNP水平较治疗前均明显下降;3组患者PCI治疗后6个月的超声心动图比较,患者左室射血分数、左室舒张末期容积、左室收缩末期容积B组、C组与A组相比差异有统计学意义(P<0.05),C组与B组比较差异也有统计学意义(P<0.05)。结论:血浆BNP水平可反映AMI的严重程度;BNP增加的程度与梗死的范围呈正相关;AMI患者急诊PCI后BNP水平有显著下降趋势;BNP水平可能可以作为患者左室功能及心室重构的预测因子。
Objective: To observe the changes of brain natriuretic peptide (BNP) levels in patients with acute myocardial infarction (AMI) before and after percutaneous coronary intervention (PCI) and its relationship with left ventricular function and ventricular remodeling, The role of prognosis in the treatment of AMI patients. Methods: One hundred and twenty patients with ST-elevation acute myocardial infarction (STEMI) undergoing emergency PCI within 12 hours after onset were enrolled in this study. Plasma BNP levels were measured by enzyme-linked immunosorbent assay The left ventricular ejection fraction was measured by echocardiography before discharge. The patients were divided into 3 groups according to BNP level at 7 days after PCI: group A was less than 100ng / L, group B was 100-400ng / L, group C was 400ng / L. All patients underwent echocardiography at 6 months after operation, and left ventricular function and ventricular remodeling were evaluated according to left ventricular ejection fraction, left ventricular end-diastolic volume, and left ventricular end-systolic volume. Results: The level of BNP was positively correlated with the extent of AMI and negatively correlated with left ventricular ejection fraction. The level of BNP in different myocardial infarction sites after PCI was significantly lower than that before treatment. Echocardiography was performed at 6 months after PCI in 3 groups Comparing the left ventricular ejection fraction, the left ventricular end-diastolic volume, the left ventricular end-systolic volume in group B, the difference between group C and group A was statistically significant (P <0.05), and the difference between group C and group B was also statistically significant Significance (P <0.05). CONCLUSIONS: Plasma BNP level can reflect the severity of AMI. The extent of BNP increase is positively correlated with infarct size. BNP level in emergency PCI patients after AMI is significantly decreased. BNP level may be used as prediction of left ventricular function and ventricular remodeling factor.