AMI患者血浆BNP,ET,CRP,ANP水平变化与临床观察分析  

Clinical Analysis of the Changes of Plasma BNP, ET, CRP and ANP Levels in Patients with Acute Myocardial Infarction

作　　者：杜同信[1] 王自正[1] 王书奎[1] 罗骏[2] 

机构地区：[1]南京医科大学附属南京第一医院放免中心,中心实验室,210006 [2]南京医科大学附属南京第一医院心脏病研究所

出　　处：《放射免疫学杂志》2004年第1期6-7,共2页Journal of Radioimmanology

摘　　要：目的 :观察急性心肌梗死 (AMI)患者血浆中脑钠肽、内皮素、C -反应蛋白、心钠素水平变化 ,探讨AMI发病机制 ,为其诊断、治疗及预后判断提供依据。方法 :应用免疫放射分析及酶联免疫分析的方法对 4 6例AMI患者治疗前后和 30例正常对照者血浆中的BNP、ET、CRP、ANP水平进行检测。结果 :AMI患者血浆中BNP、ET、CRP、ANP治疗前后比较有显著性差异 (p <0 0 0 1 ) ,正常对照组与AMI治疗前比较有显著性差异 (p <0 0 0 1 ) ,BNP与CRP在AMI治疗前水平变化比较呈正相关 (r=0 874 ) ,治疗后呈明显的下降趋势其相关系数为(r=0 6 5 4 ) ,AMI治疗前后ANP与ET比较呈正相关 ,但AMI经溶栓和相应的支持治疗后ANP水平基本恢复到正常水平 (p >0 0 5 ) ,而BNP、ET、CRP水平虽然下降明显 ,但与正常组比较仍有明显差异 (p <0 0 5 )。结论 :AMI血浆中BNP、ANP、ET、CRP水平的变化说明其参与了急性心肌梗死发生、发展 ,特别是冠状动脉粥样斑块的形成和 (或 )破裂及血栓形成 ,其炎症因子是主要因素。因此 ,四项指标的观察分析对AMI诊断、治疗、预后判断具有重要意义。Objective To explore the pathogenesis and provide new criteria for diagnosis and outcome prediction of acute myocardial infarction (AMI) by observing the changes of plasma levels of brain natriuretic peptide (BNP), endothelin (ET), CRP and atrial natriuretic peptide (ANP) in patients with AMI. Methods Plasma BNP, ET, CRP and ANP levels in 46 patients with AMI at admission and 7days after starting treatment as well as in 30 controls were measured with ELISA (for BNP, CRP) and IRMA (for ET, ANP) respectively. Results Before treatment, the plasma levels of the four markers were significantly higher in the patients than those in the controls ( p <0 001). With treatment, the levels decreased significantly (vs before freatment, p <0 001). Plasma levels of ANP approached normal after treatment (vs controls, p >0 05), but plasma levels of the other three markers remained higher than normal (vs controls, p <0 05). Plasma BNP levels were positively correlated to CRP levels ( r =0 874 at admission r =0 654 after treatment). Plasma ANP and ET levels were mutually positively correlated. Conclusion Changes of the plasma levels of the four markers indicate that these factors possibly participate in the pathogenesis of AMI, especially related to the formation and disruption of atheromatous plaques, leading to thrombosis and infarction. Dynamic measurement of them is clinically important for diagnosis, management and predicting outcome of the disease.

关 键 词：急性心肌梗死 血浆 脑钠肽 内皮素 C-反应蛋白 心钠素 发病机制 免疫放射分析 酶联免疫分析 炎症因子 

分 类 号：R542.22[医药卫生—心血管疾病]