经急诊PCI治疗的急性心肌梗死患者血浆N氨基末端脑钠肽前体水平变化的临床意义  

Clinical and prognostic significance of measuring plasma NT-proBNP levels of acute myocardial infarction patients with urgent percutaneous coronary intervention

作　　者：刘静[1] 陈群[1] 龚俊荣[1] 陆永怡[1] 王健康[1] 吕克[1] 

机构地区：[1]南京医科大学附属苏州医院(本部)心内科,215002

出　　处：《中国现代医药杂志》2010年第7期31-34,共4页Modern Medicine Journal of China

摘　　要：目的探讨血浆N氨基末端脑钠肽前体(NT-proBNP)在行急诊经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者的临床意义。方法荧光免疫法检测72例行急诊PCI治疗的AMI患者入院时血浆NT-proBNP和肌钙蛋白I(cTnI)浓度及入院第7天血浆NT-proBNP浓度,经超声心动图测定入院1周时左心室射血分数(LVEF)及左心室舒张末期内径(LVEDD)。随访观察发病3月内是否发生心衰、再梗死、梗死后心绞痛、心血管死亡等心血管事件,比较心血管事件组与无心血管事件组之间相关指标的差别。分析两组入院时血浆NT-proBNP和cTnI及入院第七天血浆NT-proBNP和LVEF、LVEDD的相关性。结果 45例患者未发生心血管事件,27例患者发生心血管事件,且两组患者入院时血浆NT-proBNP均与cTnI呈正相关,入院第7天血浆NT-proBNP浓度较入院时明显降低(P<0.05),入院第7天血浆NT-proBNP与LVEDD呈正相关、与LVEF呈负相关。结论血浆NT-proBNP浓度是反映左心室功能不良的更敏感和特异的指标,可以反映心肌坏死程度并预测AMI患者近期预后。Objective To investigate the value of plasma NT-proBNP in the evaluation of heart function and prognosis in patients of acute myocardial infarction with urgent percutaneous coronary intervention. Methods 72 patients of AMI with urgent PCI were selected, the plasma NT-proBNP and cTnI levels were measured by fluorescent immunoassay in admission and 7days after respectively, the left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were detected at the same day by color Doppler. Cardiovascular events, including heart failure, recurrent myocardial infarction, postinfarction angina pectoris and death of cardiovascular, were observed in all patients within three months. Compared the levels of plasma NT-proBNP, cTnI, LVEF and LVEDD between the two groups: with and without cardiovascular events. The correlation of NT-proBNP with LVEF and LVEDD were analyzed with Spearman regression analysis. Results In 72 patients, there were 45 patients had no cardiovascular events and 27 patients with cardiovascular events.The correlation between levels of plasma NT-proBNP and cTnI was found at admission. The level of plasma NT-proBNP in 7 days later was significantly lower than the level of admission, and it was positively correlated with the LVEDD and negatively with LVEF. Conclusion The level of plasma NT-proBNP is a sensitive and specific maker for diagnosis of heart function. NT-proBNP can reflect the extent of myocardial infarction and predict the recent prognosis of patients with AMI.

关 键 词：血浆N氨基末端脑钠肽前体 急性心肌梗死 急诊经皮冠状动脉介入治疗 近期预后 肌钙蛋白I左心室射血分数 左心室舒张末期内径 

分 类 号：R542.22[医药卫生—心血管疾病]