重组人脑利钠肽对行急诊冠状动脉介入治疗的前壁心肌梗死患者左室功能的影响

摘要

Objective To investigate the effects of intravenous recombinant human brain natriuretic peptide (rhBNP) after primary percutaneous coronary intervention (PCI) on neuroendocrine hormone level, inflammatory factor level and left ventricular function in patients with anterior wall acute myocardial infarction ( AMI ) . Methods Eighty consecutive patients with anterior wall AMI after primary PCI were randomly divided into therapy group (n=40) and control group (n=40).Patients in therapy group were treated with intravenous rhBNP (1.5 μg/kg) followed by continuous infusion [0.01μg/(kg・ min)]for 72 h and then 0.5 mg/d for 3 days while the control group received conventional treatment.The neuroendocrine hormone level, inflammatory factor level and ventricular function were measured on admission and 7 days later.The major adverse cardiac events ( MACE) were observed during in hospital.Results No significant differences of neuroendocrine hormone level, inflammatory factor level and ventricular function were found between the two groups on admission (P>0.05).The levels of NE, ET-1, PRA, AngⅡand ALD in therapy group were markedly decreased compared with control group after rhBNP treatment (P<0.05), while no apparently differences of ADH were found between the two groups ( P >0.05 ) .The levels of IL -6, hsCRP, sICAM -1 and sVCAM -1 in therapy group were also significantly decreased compared with control group after rhBNP treatment ( P<0.05).After rhBNP treatment the LVEF was significantly increased and LVEDD was significantly decreased compared with control group (P<0.05) ,while no markedly differences of LAD were found (P>0.05).No adverse events during drug infusion were observed and MACE during in hospital was also similar in both groups.Conclusion Patients with anterior wall AMI after primary PCI treated with rhBNP can markedly inhibit left ventricular remodeling and improve left ventricular function which may be related with modulatory effects of rhBNP on neuroendocrine hormone and local inflammatory state.%目的：探讨重组人脑利钠肽（ rhBNP）对行急诊冠状动脉介入（ PCI）治疗的前壁心肌梗死患者血浆神经内分泌激素、炎症因子及左室功能的影响。方法序贯入选80例在我院行急诊PCI治疗的前壁心肌梗死患者，随机分为治疗组和对照组，治疗组PCI术后在常规药物治疗的基础上以1．5μg／kg负荷剂量静推rhBNP，随后以0．01μg／（kg・ min）连续给药72 h，再以0．5 mg／d连续给药3 d；对照组单纯给予常规药物治疗；比较两组患者神经内分泌激素、血浆炎症因子、左室功能及不良反应的发生情况。结果两组患者治疗前的一般临床资料、神经内分泌激素水平、血浆炎症因子水平及心功能结果比较差异均无统计学意义（P＞0．05）；治疗组在给药后血浆去甲肾上腺素（NE）、内皮素－1（ET－1）、肾素（PRA）、血管紧张肽Ⅱ（AngⅡ）及醛固酮（ALD）水平较对照组明显降低，差异有统计学意义（P＜0．05），抗利尿激素（ADH）水平与对照组比较差异无统计学意义（P＞0．05）；治疗组在给药后可溶性细胞间黏附分子－1（sICAM－1）、血管细胞黏附分子－1（sVCAM－1）、白细胞介素－6（IL－6）及高敏C－反应蛋白（hsCRP）水平显著低于对照组，差异有统计学意义（ P＜0．05）；治疗组在给药后左心室射血分数（ LVEF）显著高于对照组，左心室舒张末期内径（LVEDD）显著低于对照组，差异有统计学意义（P＜0．05），左心房内径（LAD）较对照组减低，但差异无统计学意义（P＞0．05）；研究未发现与rhBNP相关的严重不良反应，两组患者住院期间主要心血管事件（MACE）发生率差异无统计学意义（P＞0．05）。结论急性前壁心肌梗死患者急诊PCI术后应用rhBNP可显著抑制左心室重塑，改善患者左室功能，机制可能与其对神经内分泌激素及局部炎症状态的调节作用有关。