重组人脑钠肽对急性ST段抬高型心肌梗死患者急诊PCI术后心室重构的影响  

Influence of recombinant human brain natriuretic peptide on ventricular remodeling in patients with acute ST-segment elevation myocardial infarction after emergency PCI

作　　者：王艳林[1] 高淑贤[1] 张兰芳[2] 王艳飞[2] 栗建辉[3] 张旭[1] WANG Yan-lin;GAO Shu-xian;ZHANG Lan-fang;WANG Yan-fei;LI Jian-hui;ZHANG Xu

机构地区：[1]河北省保定市河北大学,保定071000 [2]河北大学附属医院心内科,保定071000 [3]河北大学附属医院超声科,保定071000

出　　处：《中国循证心血管医学杂志》2017年第4期433-435,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省医学科学研究重点课题计划指令性项目(20150062);河北大学附属医院青年基金项目(2015Q015)

摘　　要：目的分析重组人脑钠肽(rh BNP)对急性ST段抬高型心肌梗死(STEMI)患者行急诊冠状动脉介入治疗(PCI)后心室重构的影响。方法选取2014年3月~2016年5月期间于河北大学附属医院治疗的STEMI患者88例,其中男性73例,女性15例。所有患者随机分为rh BNP组(42例)与对照组(46例)。rh BNP组失访3例,对照组失访2例,最终纳入rh BNP组(39例)和对照组(44例)。两组患者均给予常规药物治疗,并于发病12 h内行PCI,rh BNP组术后静脉给予rh BNP。术后12 h内及6个月采用超声心动图测定左室舒张末期容积(LVEDV)、左室射血分数(LVEF),并计算左室舒张末期容积增长率(△LVEDV%),以△LVEDV≥15%定义为心室重构。术后随访6个月,记录主要不良心血管事件。结果两组术后6个月的LVEF值较术后12 h内的测量值改善,rh BNP组较对照组改善更明显,[(54.92±3.78)%vs.(52.77±2.90)%],差异有统计学意义(P均<0.05)。术后6个月,rh BNP组较对照组LVEDV测量值降低,差异有统计学意义(P<0.05)。术后6个月时,rh BNP组左室重构2例(5.1%),对照组15例(34.1%),rh BNP组明显低于对照组,差异有统计学意义(P<0.05)。随访6个月,rh BNP组主要不良心血管事件发生4例(10.3%),明显低于对照组的14例(31.8%),差异有统计学意义(P<0.05)。结论急性STEMI患者急诊介入治疗术后早期应用rh BNP可改善心室重构,且主要不良心血管事件发生率较低。Objective To analyze the influence of recombinant human brain natriuretic peptide(rhBNP)on ventricular remodeling in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods STEMI patients(n=88,male73and female15)were chosen from the Affiliated Hospital of Hebei University from Mar.2014to May2016.All patients were randomly divided into rhBNP group(n=42)and control group(n=46).There were3cases missed in rhBNP group and2missed in control group,and finally there were39cases in rhBNP group and44in control group.All patients in2groups were given routine drugs and PCI within12h after STEMI onset,and rhBNP group was intravenously given rhBNP.The indexes of left ventricular end-diastolic volume(LVEDV)and left ventricular ejection fraction(LVEF)were detected after PCI for12h and6m,and△LVEDV%was calculated and△LVEDV≥15%was defined as ventricular remodeling.The patients were followed up for6m for recording major adverse cardiovascular events(MACE).Results The value of LVEF was improved after PCI for6m compared with that after PCI for12h,which was more significant in rhBNP group compared with control group[(54.92±3.78)%vs.(52.77±2.90)%,allP<0.05].The value of LVEDV decreased in rhBNP group compared with control group after PCI for6m(P<0.05).There were2patients(5.1%)with left ventricular remodeling in rhBNP group and15(34.1%)in control group after PCI for6m(P<0.05).After followed up for6m,there were4patients(10.3%)with rhBNP group and14(31.8%)in control group(P<0.05).Conclusion The early application of rhBNP after Emergency PCI can relieve ventricular remodeling and reduce incidence of MACE in patients acute STEMI.

关 键 词：急性心肌梗死 急诊PCI 重组人脑钠肽 心室重构 

分 类 号：R541.4[医药卫生—心血管疾病]