ACS患者直接PCI术后血浆NT-proBNP水平变化与心功能及预后关系的研究  

Research of the relationship of plasma NT-proBNP levels and cardiac function and prognosis in ACS patients after primary PCI

作　　者：李玉耕[1] 孟竹[2] 崔国方[1] 

机构地区：[1]青岛大学医学院附属海慈医疗集团心内科,山东省266033 [2]青岛市市立医院东院区特需一科

出　　处：《中国心血管病研究》2011年第3期184-187,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨急性冠脉综合征（ACS）患者行冠脉介入治疗（PCI）后血浆N末端B型尿钠肽前体（NT-proBNP）的水平变化与心功能及预后的关系.方法 98例ACS患者根据是否行直接PCI手术治疗,分为PCI手术治疗组和非PCI治疗组,观察治疗前、治疗后及随访3个月时NT-proBNP水平的变化及与心脏功能的关系.同时根据治疗后NT-proBNP的水平分为3组：A组NT-proBNP＜125 pg/ml,B组125 pg/ml≤NT-proBNP＜450 pg/ml,C组NT-proBNP≥450 pg/ml.随访3个月,观察NT-proBNP的水平与预后的关系.结果 行PCI组NT-proBNP水平下降程度明显高于未行PCI组（P＜0.05）.随访3个月时发现,与对照组相比,行PCI组NT-proBNP水平下降更显著（125.5±50.4比458.6±186.5,P＜0.05）,对应的心功能改善更明显,左室舒张末期内径明显缩小（5.01±0.68 比5.42±1.30,P＜0.05）,左室射血分数明显增加（54.00±6.50 比 46.00±12.90,P＜0.05）.主要不良心脏事件（MACE）的发生情况C组明显高于A组（P＝0.006＜0.01）,也高于B组（P＝0.028＜0.05）,与A组相比,B组的MACE发生率有上升趋势,但差异无统计学意义（P＝0.432＞0.05）.结论 ACS患者直接PCI治疗后NT-proBNP水平下降明显,心脏功能保存较好.血浆NT-proBNP水平在一定程度上可以反映心脏的功能状态,且与患者的预后呈明显的负相关.Objeetlve To study the relationship between plasma N-terminal pro-B-type natriuretic （NT-proBNP） levels and cardiac function, and prognosis in acute coronary syndrome （ACS） patients after prima- ry pereutaneous coronary intervention（PCl）. Methods According to the patients whether underwent primary PCI, 98 ACS patients were divided into PCI treatment group and the non-PCI treatment group. The association of cardiac function and NT-proBNP levels before and after three months treatment was observed respectively. Meanwhile according to the levels of the NT-proBNP after treatment, all the patients were divided into three groups, includ- ing A group（NT-proBNP〈125 pg/ml）, B group （125 pg/ml≤NT-proBNP〈450 pg/ml） and C group （NT-proB- NP〉450 pg/ml）. The relationship between the levels of the NT-proBNP and prognosis was analyzed. Results The NT-proBNP levels in primary PCI treatment group decreased significantly compared with non-PCI treatment group （≤0.05）, and compared with control group in three mouths, NT-proBNP levels decreased more significantly in PCI group（ 125.5±50.4 vs 458.6±186.5, P〈0.05）, cardiac function improved more obviously, left ventricttlar end diastolic diameter reduced significantly （5.01±0.68 vs 5.42±1.30, P〈0.05 ）, left ventricular ejection fraction increased apparently （54.00±6.50 vs 46.00±12.90, P〈0.05 ）. The incidence of MACE in group C was significantly higher than group A （P〈0.01）, also higher than the B group （P〈0.05）. The incidence of MACE in group B was higher than group A, but the two groups had no significant difference. Conclusion Early plasma NT-proBNP levels decrease significantly after primary PCI treatment in ACS patients, and it can reflect the degree of cardiac function, and have a significant negative correlation to prognosis of the patients.

关 键 词：急性冠脉综合征 冠脉介入治疗 血浆N末端B型尿钠肽前体 心功能 预后 

分 类 号：R543.3[医药卫生—心血管疾病]