急性心肌梗死患者急诊冠状动脉介入治疗前后血浆心钠素的动态变化及其预后意义  

Serial Changes and Prognostic Significance of Atrial Natriuretic Polypeptide in Patients with Acute Myocardlal Infarction Undergoing Emergency Coronary Intervention

作　　者：彭建军[1] 吴旸[2] 胡大一[1] 高晓慧[1] 张宇晨[3] 贾三庆[3] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,北京100730 [2]北京海淀医院,北京100080 [3]首都医科大学北京友谊医院,北京100050

出　　处：《中国医药导刊》2004年第5期340-342,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:选择心钠素(ANP)作为研究指标,探讨急性心肌梗死(AMI)患者行急诊PCI前后血浆中ANP的变化规律和可能机制及预后意义。方法:以接受直接经皮腔内冠状动脉血管成形术(PTCA)和挽救性PTCA治疗的80例AMI患者作为研究对象,动态观察了入院即刻及血管开通后1,4,8,24,48h及第7天血浆中ANP的变化规律。结果:AMI患者入院即刻的ANP显著高于正常,再灌注后24h达峰值,而后下降,第7天时仍高于入院时水平;梗后心功能Killip Ⅰ级组和Killip Ⅱ-Ⅳ级组比较,各时间点均显著低于后者,P值均<0.05;同时,再灌注后24h ANP水平与出院前射血分数及住院期间的MB峰值均呈负直线相关;随访1年发现出现心功能不全患者再灌注后24h的血浆ANP水平显著高于心功能正常者。结论:AMI患者行直接PTCA和挽救性PTCA后血浆ANP水平明显升高,再灌注后24h达峰值;ANP也可反映心肌梗死范围的大小;ANP峰值可作为AMI患者急诊冠脉介入后心功能长期预后的指标。Objective: To discuss the serial changes and prognostic significance of ANP in patients with AMI undergoing emergency percutaneous coronary intervention and to improve the therapy of heart dysfunction. Methods: Eighty patients with AMI undergoing primary PTCA or rescue PTCA were enrolled. Venous blood for the measurements of ANP was sampled immediately after admission and 1, 4, 8, 24, 48 hours and 7 days after reperfusion.Results: Compared with control subjects, plasma ANP in patients group on admission is significantly higher (P < 0.001). After successful reperfusion, ANP increases with the peak value at 24 hours, and then decreases gradually. The level of ANP on seventh day is still higher than that on admission. The ANP values of all time in heart function of Killip Ⅱ - Ⅳ group are higher than those in Killip Ⅰ (P < 0.05) . Ejection fraction and the peak value of MB are inversely correlated with the level of ANP at 24 hours after reperfusion. The values of ANP of patients with heart dysfunction at 24 hours after reperfusion are significantly higher than those of patients without heart dysfunction during the follow - up of 1 year.Conclusion: The level of plasma ANP increases in patients with AMI undergoing primary or rescue PTCA. The peak value appears at 24 hours after reperfusion. The level of plasma ANP is related with infarction size. Measurement of plasma ANP may be helpful in identifying patients at risk for heart dysfunction.

关 键 词：ANP 患者 再灌注 AMI 血浆 入院 预后 挽救 指标 开通 

分 类 号：R542.22[医药卫生—心血管疾病] R541[医药卫生—内科学]