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目的:观察急性心肌梗死(AMI)患者行冠状动脉支架置入术前后脑钠肽(BNP)水平的变化以及BNP对术后远期心室重塑的预测价值评价。方法:入选AMI住院治疗的患者32例作为试验组,在诊断为AMI后2~4周时行冠状动脉支架置入术,另入选同期AMI未行介入治疗的患者28例作为对照组。所有入选患者均在入院时、介入术后72h检测BNP,采用酶联免疫吸附法分析;并于入院时,介入术后72h以及6个月时行超声心动图检查,计算左室重量指数(LVMI)和LVMI变化值(Δ1LVMI、Δ2LVMI)。结果:2组患者基线特征差异无统计学意义(P>0·05)。入院时BNP及LVMI2组间相似(P>0·05);介入术后72h试验组BNP水平低于对照组(P<0·05),且较入院时降低(P<0·05),而LVMI2组间差异无统计学意义(P>0·05);介入术后6个月试验组LVMI,Δ1LVMI和Δ2LVMI均较对照组明显减低(P<0·05);对照组LVMI较入院时升高。相关分析表明介入术后72h BNP水平与Δ2LVMI呈正相关(r=0·56,P<0·01)。结论:AMI患者行冠状动脉支架置入术治疗可使血浆BNP水平下降,术后BNP水平与LVMI的变化呈正相关,即BNP对远期心室重塑有一定的预测价值。
Objective: To investigate the changes of brain natriuretic peptide (BNP) in patients with acute myocardial infarction (AMI) before and after coronary stenting and the predictive value of BNP in predicting postoperative long-term ventricular remodeling. Methods: Thirty-two AMI patients were enrolled in the study. Coronary stenting was performed 2 to 4 weeks after AMI. Another 28 patients undergoing AMI without intervention were selected as control group. All the patients were enrolled at the time of admission, BNP was detected at 72h after PCI, and analyzed by enzyme-linked immunosorbent assay. At admission, 72h and 6 months after PCI, echocardiography was performed to calculate the left ventricular mass index (LVMI ) And LVMI changes (Δ1LVMI, Δ2LVMI). Results: There was no significant difference in baseline characteristics between the two groups (P> 0.05). The BNP levels of BNP and LVMI2 group were similar at admission (P> 0.05). The level of BNP at 72h after PCI was lower than that of control group (P <0.05), and was lower than that at admission (P <0.05) There was no significant difference between the two groups (P> 0.05). LVMI, Δ1LVMI and Δ2LVMI in the experimental group were significantly lower than those in the control group at 6 months after PCI (P0.05) high. Correlation analysis showed that there was a positive correlation between BNP level and Δ2LVMI at 72h after PCI (r = 0.56, P <0.01). CONCLUSIONS: Coronary stent implantation in patients with AMI can decrease plasma BNP levels. There is a positive correlation between postoperative BNP levels and changes in LVMI. That is to say, BNP can predict the long-term ventricular remodeling.