早期应用重组人B型利钠肽对ST段抬高型心肌梗死患者急诊冠状动脉介入术后心肌梗死面积的影响  

Effects of pretreatment with recombinant human B-type natriuretic peptide on infarct size in patients with acute ST-segment elevation myocardial infarction undergoing primary pereutaneous coronary intervention

作　　者：李世强[1] 傅向华[1] 代玉涵 刘晨[1] 汪雁博[1] 李伟[1] 吴伟力[1] 谷新顺[1] 郝国桢[1] 范卫泽[1] 苗青[1] 姜云发[1] 

机构地区：[1]河北医科大学第二医院心血管内科,石家庄050000

出　　处：《中华心血管病杂志》2015年第11期954-959,共6页Chinese Journal of Cardiology

基　　金：基金项目：河北省卫生厅课题（20110343）

摘　　要：目的 前瞻性探讨早期应用重组人B型利钠肽（rhBNP）对急性前壁ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）后梗死相关动脉（IRA）血流灌注、心肌梗死面积及左心室早期重构的影响。 方法 为前瞻性病例对照研究，连续入选2011年1月至2013年12月就诊于河北医科大学第二医院的发病时间〈12 h的急性前壁STEMI病例，采用随机数字表法分为静脉注射rhBNP组48例（PCI术前至少5 min开始应用，首剂给予冲击量1.5 μg/kg弹丸式静脉注射，随后以0.007 5～0.03 μg·kg–1·min–1维持静脉注射5 d）和静脉注射硝酸甘油（NIT）组45例（至少PCI术前5 min开始应用，10～100 μg/min维持静脉注射5 d），PCI术中均采用缺血后适应（PC）技术。比较两组患者IRA开通时TIMI血流、校正TIMI血流帧数、TIMI心肌灌注分级，住院期间心肌坏死标志物变化和超声心动图指标；随访6个月，通过超声心动图比较两组左心室形态、功能情况。 结果 两组患者基线临床特点、IRA开通时间及PCI术中选择的支架长度、直径等差异均无统计学意义；PCI术后rhBNP组IRA的TIMI 3级血流获得率及TIMI心肌灌注3级获得率差异均无统计学意义[95.8%（46/48）比86.7%（39/45），P＝0.162；72.9%（35/48）比62.2%（28/45），P＝0.500]，而rhBNP组校正TIMI血流帧数明显低于NIT组（21.0±8.7比28.2±14.8，P＝0.005）；计算机辅助测定PCI术后72 h的血清肌酸磷酸激酶MB型同工酶（CK-MB）曲线下面积，rhBNP组较NIT组减少27%[（3 249±1 101）U/L比（4 474±1 661）U/L, P＝0.010]，血清肌钙蛋白I（TnI）曲线下面积亦较NIT组减少18%[（3 670±942）μg/L比（4 541±1 098）μg/L, P＝0.021]；术后1周，rhBNP组患者左心室射血分数（LVEF）较NIT组有升高趋势，rhBNP组患者E/e＇指数较NIT组有显著改善（11.95±3.31比14.60±4.09，P＝0.030），比较两组患者室壁运动积分指数�ObjectivesTo investigate whether the administration of recombinant human B-type natriuretic peptide （rhBNP） before primary percutaneous coronary intervention （PCI） could further limit the infract size, improve left ventricular function, and alleviate cardiac dilation in patients with acute ST-segment elevation myocardial infarction（STEMI）. MethodsA total of 93 consecutive patients presenting chest pain within 12 hours from the onset, suspicious of first STEMI located at anterior wall undergoing primary PCI, were eligible for enrollment and randomly assigned to either rhBNP group （rhBNP administration starting at 5 min before PCI, 1.5 μg/kg bolus intravenous injection followed by 0.007 5-0.03 μg·kg-1·min-1 for up to 120 hours, n=48） or nitroglycerin （NIT） group （NIT treatment starting at 5 min before PCI, 10-100 μg/min intravenous infusion for 120 hours, n=45）. Primary PCI was performed in both groups using post-conditioning （PC） technique. TIMI flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade were compared between the two groups at the time of infarct related artery （IRA） re-patency. The levels of serum creatine kinase MB isoenzyme （CK-MB） and troponin I （TnI） were measured. Echocardiography was performed at baseline 7 days and 6 months later. ResultsBaseline characteristics were similar between the two groups. The percentage of TIMI grade 3 and TIMI myocardial perfusion grade 3 after PCI both tended to be higher in rhBNP group than those in NIT group（95.8%（46/48） vs. 86.7%（39/45）, P=0.162） and （72.9%（35/48）vs. 62.2%（28/45）, P=0.500）. The corrected TIMI frame count was significantly decreased in rhBNP group （21.0±8.7 vs. 28.2±14.8, P=0.005）. The myocardial infarct size expressed as the AUC of CK-MB （（3 249±1 101）U/L vs. （4 474±1 661）U/L, P=0.010） or AUC of TnI （（3 670±942）μg/L vs. （4 541±1 098）μg/L, P=0.021） was significantly decreased in rhBNP group compared with those in NIT

关 键 词：心肌梗死 利钠肽 脑 血管成形术 经腔 经皮冠状动脉 心肌再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]