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目的:进一步探讨重组人B型利钠肽(rhBNP)对急性前壁心肌梗死经皮冠状动脉介入治疗(PCI)术后醛固酮水平及内皮功能的影响。方法:189例急性前壁心肌梗死患者于直接PCI术后随机分为常规治疗组(n=97)和rhBNP组(n=92)。观察二组患者治疗前后血浆醛固酮、一氧化氮、内皮素-1、血清K+、Na+浓度的变化,比较两组超声心动图的检查结果。结果:rhBNP组与常规治疗组比较,治疗后血浆醛固酮、内皮素-1浓度水平下降,一氧化氮浓度升高,差异有统计学意义(P<0.05)。rhBNP组治疗后与治疗前比较,血清K+浓度升高、Na+浓度下降,差异有统计学意义(P<0.05);rhBNP组治疗后与常规治疗组比较,左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)降低,左心室射血分数(LVEF)升高,差异有统计学意义(P<0.05)。结论:急性前壁心肌梗死直接PCI术后应用rhBNP可以拮抗醛固酮的过度激活,改善血管内皮功能,进而改善心室重构及心功能。
Objective: To investigate the effect of recombinant human B-type natriuretic peptide (rhBNP) on aldosterone level and endothelial function after percutaneous coronary intervention (PCI) in patients with acute anterior myocardial infarction. Methods: A total of 189 patients with acute anterior myocardial infarction were randomly divided into routine treatment group (n = 97) and rhBNP group (n = 92) after PCI. The changes of plasma aldosterone, nitric oxide, endothelin-1, serum K + and Na + concentrations before and after treatment were observed. The echocardiographic results were compared between the two groups. Results: Compared with the conventional treatment group, the levels of plasma aldosterone, endothelin - 1 and the concentration of nitric oxide in rhBNP group were significantly increased (P <0.05). Compared with pretreatment group, serum K + concentration and Na + concentration decreased significantly in rhBNP group after treatment (P <0.05); Compared with conventional treatment group, the left ventricular end diastolic volume index (LVEDVI) Left ventricular end systolic volume index (LVESVI) decreased, left ventricular ejection fraction (LVEF) increased, the difference was statistically significant (P <0.05). CONCLUSION: The rhBNP administration after direct PCI in acute anterior myocardial infarction can antagonize the over-activation of aldosterone, improve the endothelial function, and then improve the ventricular remodeling and cardiac function.