远端缺血适应处理对高龄急性ST段抬高型心肌梗死患者急诊介入术后氨基末端脑钠肽前体水平的影响研究  

The effect of RIC on serum levels of NT-proBNP in aged patients with STEMI following PCI treatment

作　　者：戴大银 邓学军[1] 余冬梅[1] DAI Da-yin;DENG Xue-jun;YU Dong-mei(Department of Cardiology,Suining Center Hospital.Suining 629000,China)

机构地区：[1]遂宁市中心医院心内科,四川省遂宁市629000

出　　处：《中国心血管病研究》2020年第3期222-226,共5页Chinese Journal of Cardiovascular Research

基　　金：四川省卫计委科研课题(17PJ1021)。

摘　　要：目的 探讨远端缺血适应处理(RIC)对高龄急性ST段抬高型心肌梗死(STEMI)患者急诊介入术后氨基末端脑钠肽前体(NT-proBNP)水平的影响.方法 选取2017年6月至2019年5月期间于我院治疗的高龄STEMI患者共66例,根据随机数字列表分为RIC组(33例)和对照组(33例).RIC组在常规治疗的基础上,进行RIC治疗13次,包括开通罪犯血管之前1次,经皮冠状动脉介入治疗(PCI)后12次(术后每日4次,连续3日).分别于PCI前(T0)和PCI后72 h(T1)检测NT-proBNP水平波动评价PCI后心功能恶化程度.分别于T1和PCI后4周(T2)进行超声心动图检测评价PCI后心功能恢复情况.结果 两组患者血清NT-proBNP水平在T1明显升高[RIC组:(1424.91±376.24)ng/L比(2678.44±655.75)ng/L,t=12.510,P<0.001;对照组:(1514.33±481.04)ng/L比(4139.34±692.22)ng/L,t=23.510,P<0.001],且对照组明显高于RIC组[(2678.44±655.75)ng/L比(4139.34±692.22)ng/L,t=11.560,P<0.001],提示RIC组患者PCI后心功能恶化明显轻于对照组.T2时两组患者LVEF水平均明显升高[RIC组:(47.22±2.09)%比(50.66±2.13)%,t=8.703,P<0.001;对照组:(47.45±2.22)%比(48.88±2.55)%,t=3.193,P<0.001],且RIC组高于对照组[(50.66±2.13)%比(48.88±2.55)%,t=4.044,P<0.001],而RIC组FS[(36.44±2.31)%比(37.31±2.51)%,t=1.925,P=0.031]和E/A(0.83±0.11比0.87±0.08,t=2.220,P=0.016)水平明显升高,提示RIC组患者PCI后心功能恢复情况明显优于对照组.RIC与△NT-proBNP呈负相关(r=-0.556,P<0.001),而与各个超声心动图指标波动呈正相关,相关系数在0.277-0.529之间,与△LVEF相关性最大(r=0.529,P<0.001).结论 对于高龄STEMI患者来说,RIC有助于减少PCI后心功能恶化程度,促进心功能的恢复.Objective To study the effect of remote ischemia conditioning(RIC)on serum levels of Nterminal pro brain natriuretic peptide(NT-proBNP)in aged patients with STEMI following PCI treatment.Methods 66 aged STEMI patients were enrolled and divided into RIC group(n=33)and control group(n=33).The patients in RIC group were under 13 times RIC treatment.The levels of NT-proBNP on TO(before PCI)and T1(72 hours after PCI)were used to evaluate the deterioration of cardiac function.Ultrasonic cardiogram was used on T1 and T2(4 weeks after PCI)to evaluate recovery of cardiac function.Results The levels of NT-proBNP were increased in both group on T1[RIC group:(1424.91±376.24)ng/L vs.(2678.44±655.75)ng/L,n=12.510,P<0.001;control group:(1514.33±481.04)ng/L vs.(4139.34±692.22)ng/L,n=23.510,P<O.001.On T1,the levels of NT-proBNP in control group were higher than those in RIC group[(2678.44±655.75)ng/L vs.(4139.34±692.22)ng/L,n=11.560,P<0.001,which indicated that the levels of deterioration of cardiac function in RIC group were lower than those in control group(P<0.05).The levels of LVEF were elevated in both group on T2[RIC group(47.22±2.09)%vs.(50.66±2.13)%,[8.703,P<O.OO1;control group:(47.45±2.22)%vs.(4.88±2.55)%,n=3.193,P<O.OO1].Moreover,the levels of FS[(36.44±2.31)%vs.(37.31±2.51)=1.925,P=0.031]and E/A(0.83±0.11 vs.0.87±0.08,n=2.220,P=0.016)in RIC group were improved on T2.On T2,the levels of LVEF in RIC group were higher than those in control group(50.66±2.13)%vs.(48.88±2.55)%,n=4.044,P<0.001),which suggested that the levels of recovery of cardiac function in RIC group were better than those in control group(P<0.05).Correlation analysis showed that RIC was negatively related with A NT-proBNP(r=-0.529,P<O.OO1)and positively associated with each UCG index,rvalue range from 0.277 to 0.529.Conclusion RIC treatment can reduce deterioration and promote recovery of cardiac function after PCI in aged STEMI patients.

关 键 词：远端缺血适应处理 高龄 急性心肌梗死 经皮冠状动脉介入治疗 氨基末端脑利钠肽前体 

分 类 号：R542.22[医药卫生—心血管疾病]