急性心肌梗死介入治疗对脑利钠肽及心室重构的影响

摘要

目的：探讨急性 ST段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）对脑利钠肽（BNP）水平及心室重构的影响。方法：151例诊断为 STEMI的患者根据其治疗方式分为3组：A组（52例，行急诊 PCI治疗），B组（49例，择期行PCI治疗），C组（50例，予以标准药物治疗）。比较各组患者治疗前后 BNP水平及左心室重构情况。结果：三组患者治疗前BNP水平比较无统计学差异（F＝0.01，P＞0.05），治疗后各组 BNP水平均显著下降，其中 A组下降较B组、C组显著[（242.7±101.3）ng/L比（466.2±113.5）ng/L比（601.4±126.7）ng/L]，差异有显著性（P均＜0.01）。各组治疗前左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）比较差异均无显著性（P＞0.05）；治疗后，三组心室上述指标均显著升高（P＜0.05），其中 A、B组LVFS升高均较C组更明显[（28.9±7.6）％比（27.5±7.3）％比（22.6±6.9）％]，而 A 组 LVEF 较 B 组、C 组升高[（57.9±6.2）％比（53.1±6.5）％比（50.9±5.7）％]，差异有显著性（P均＜0.01）。结论：经皮冠脉介入治疗急性 ST段抬高型心肌梗死患者能有效改善心室重构，同时降低脑利钠肽水平，且急诊经皮冠脉介入治疗比择期介入治疗疗效更明显。%Objective:To explore influence of percutaneous coronary intervention (PCI)on brain natriuretic peptide (BNP)level and ventricular remodeling in patients With acute ST elevation myocardial infarction (STEMI).Meth-ods:According to their therapeutic methods,a total of 151 patients diagnosed as STEMI Were divided into group A (n=52,received emergency PCI treatment),group B (n=49,received selective PCI treatment)and group C (n=50,received standard medication).BNP level and left ventricular remodeling Were compared among three groups before treatment and after treatment.Results:There Was no significant difference in BNP level among three groups before treatment (F=0.01,P>0.05),BNP level significantly decreased among three groups after treatment,com-pared With group B and C,there Was significant decrease in BNP level [(466.2±113.5)ng/L vs.(601.4±126.7) ng/L vs.(242.7±101.3)ng/L]in group A (P<0.01 all).There Were no significant difference in left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),left ventricular ejection fraction (LVEF)and left ventricular fractional shortening (LVFS)among three groups before treatment (P>0.05 all);af-ter treatment,there Were significant increase in above ventricular indexes in three groups (P<0.05 all),compared With group C,there Were significant increase in LVFS [(22.6±6.9)% vs.(28.9±7.6)% vs.(27.5±7.3)%]in group A and B,compared With group B and C,there Was significant increase in LVEF [(53.1±6.5)% vs.(50.9± 5.7)% vs.(57.9±6.2)%]in group A (P<0.01 all).Conclusion:PCI could effectively improve ventricular re-modeling and decrease BNP level in STEMI patients,and emergency PCI shoWs more significant therapeutic effects than selective PCI.