急性广泛前壁心梗患者介入手术中和术后重组人脑利钠肽干预的研究  

Effects of Lyophilized Recombinant Human Brain Natriuretic Peptide Intervention on Acute Myocardial Infarction Patients during and post the Operation

作　　者：马晶茹[1] 金霞[1] 谭力力[1] 李飞[1] 张继红[1] 

机构地区：[1]沈阳医学院附属第二医院心内科,沈阳110034

出　　处：《中国医科大学学报》2014年第7期602-605,共4页Journal of China Medical University

基　　金：辽宁省科学技术计划(201225019)

摘　　要：目的观察新活素——重组人脑利钠肽(rh BNP)对行急诊经皮冠状动脉介入(PCI)治疗的急性前壁心梗患者缺血再灌注损伤、循环炎性因子及预后的影响。方法将首次急性广泛前壁心梗患者86例随机分为A组(即治疗组,给予直接PCI术+rh BNP)和B组(即对照组,给予直接PCI术+常规药物治疗),每组43例。观察2组患者术后即刻TIMI血流情况,2组TIMI 3级血流者心肌组织的再灌注情况,PCI术前、术后24 h测定肿瘤坏死因子ɑ(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)和脑利钠肽(BNP)水平。随访至术后6个月,观察2组患者心室重构和主要心脏不良事件发生的情况。结果 A组术后即刻无复流或慢血流的发生率显著低于B组(P<0.05);TIMI 3级血流者,PCI术后90 min ST段抬高或降低恢复的百分比、校正的TIMI帧数计数(CTFC)、1个月后室壁运动积分指数(WMSI)A组显著优于B组(P<0.05);2组患者术前BNP、CRP、TNF-α、IL-6无统计学差异;术后24 h,BNP、CRP、TNF-α、IL-6 A组显著优于B组(P<0.05)。经PCI术后6个月的随访,A组MACE发生率明显低于B组(P<0.05)。结论 rh BNP能预防和处理冠脉无复流,改善心肌组织水平的再灌注,降低炎性因子水平,改善心功能,减少临床事件的发生。Objective To study the influence of lyophilized recombinant human brain natriuretic peptide（rh-BNP） on the change of ischemia-reperfusion injury （IRI） and circulating inflammatory cytokines in acute anterior myocardial infarction （AMI） patients who received percutaneous coronary interventional （PCI） therapy,and evaluate its effect on prognosis.Methods Totally 86 first time acute anterior myocardial infarction patients were recruited and randomly divided into 2 groups as group A and group B.Group A was treated with PCI therapy and rh-BNP（n =43）,and group B received PCI therapy and conventional medical treatment （n =43）.The 2 groups were followed up for 6 months,and the immediate TIMI flow in the two groups of patients after the operation and the change of myocardium ischemia-reperfusion of patients with TIMI-3 flow were observed.The level of TNF-α,IL-6,CRP and BNP of patients before and after PCI therapy were measured.During the 6 months follow-up period,ventricle reconstruction condition and cardiovascular events of the two groups of patients were also observed.Results Compared with the control group,the rhBNP＋PCI group has a significant lower incidence of no-reflow and slow reflow immediately after the operation （P ＜ 0.05）.Compared with the control group,the group of rh-BNP＋PCI has significantly higher numbers of TIMI-3 flow patients,the percentage of recovery of ST-segment elevation or decline 90 minutes after operation,corrected thrombolysis in myocardial infarction frame count （CTFC）,and wall molionscore index （WMSI） 1 month after operation （P ＜ 0.05）.There was no statistical difference in the level of TNF-α,IL-6,CRP,and BNP of the two groups of patients before operation,but significantly lower levels of BNP,CRP,TNF-α,IL-6,which was observed in the group of rh-BNP＋PCI 24 hours after operation.（P ＜ 0.01）.Compared with the control group,the rh-BNP＋PCI group has a significantly lower incidence of major adverse cardiac events （MACE） 6 months after t

关 键 词：新活素 心肌梗死 缺血再灌注损伤 循环炎性因子 

分 类 号：R54[医药卫生—心血管疾病]