重组人脑利钠肽对冠心病患者择期PCI术后心肌损伤的影响

摘要

目的：探讨重组人脑利钠肽（ rhBNP）对冠心病患者择期经皮冠状动脉介入治疗（ PCI）术后心肌损伤的影响。方法选择行择期PCI治疗的冠心病患者210例，随机分为rhBNP组（ n ＝106）和对照组（ n ＝104）。2组患者基础治疗相同，rhBNP组于术前2 h应用rhBNP，首先以1贩．5μg／kg负荷剂量静脉注射，后以0．01μg· kg－1· min－1持续静脉泵入72 h。分别于术前、术后8 h、24 h及3 d测定2组患者血清肌酸激酶同工酶（ CK-MB ）、肌钙蛋白I （ cT-NI）、N-末端前脑利钠肽（NT-proBNP）及白介素-8（IL-8）水平。观察2组患者治疗前后血清CK-MB、cTNI、NT-proBNP和IL-8水平变化，比较2组患者术后心肌损伤发生率。结果2组术前血清CK-MB、cTNI、NT-proBNP、IL-8水平差异无统计学意义（ P ＞0．05）。 rhBNP组术后8 h2、4 h血清CK-MB峰值水平低于对照组（P ＜0．05），术后8 h、24 h及3 d血清cTNI峰值水平均明显低于对照组（ P ＜0．05）。2组术前血清NT-proBNP、IL-8水平变化，差异无统计学意义（ P ＞0．05）。 rhBNP组术后8h、24h和3d NT-proBNP、IL-8均明显低于对照组（ P ＜0．05）。 rhBNP治疗组PCI术后心肌损伤发生率明显低于对照组（ P ＜0．05）。结论冠心病择期PCI术前给予rhBNP可通过抑制交感神经-内分泌系统激活和影响炎症因子对PCI术后心肌损伤起到一定保护作用。%Objective To investigate the effects of recombinant human brain natriuretic peptide ( rhBNP ) on myocardial injury in patients with coronary heart disease ( CHD ) after selective percutaneous coronary intervention ( PCI ) . Methods Two hundred and ten patients with CHD were randomly divided into rhBNP group ( n =106 ) and control group (n=104).The patients in both groups were treated by basic treatment , however, the patients in rhBNP group were given rhBNP on 2 hours before PCI , firstly which was intravenously injected at 1.5μg/kg loading dose for 90s, then continuously intravenously infused at 0.01μg· kg-1· min-1 for 72h.The serum levels of creatine kinase-MB (CK-MB),creatine cardiac troponin I( cTNI) ,N-terminal pro brain natriuretic peptide ( NT-proBNP ) and interleukin-8 ( IL-8 ) were detected before PCI and on 8h,24h,3d after PCI for both groups .Moreover,the changes of CK-MB,cTNI,NT-proBNP,IL-8 and the incidences of postoperative myocardial injury were observed and compared between two groups .Results There were no significant differences in the serum levels of CK-MB,cTNI,NT-proBNP,IL-8 before PCI between two groups ( P >0.05).The levels of CK-MB on 8h,24h after PCI in rhBNP group were significantly lower than those in control group ( P <0.05),and the levels of cTNI on 8h,24h,3d after PCI in rhBNP group were significantly lower than those in control group ( P <0.05).There were no significant differences in the serum levels of NT-proBNP,IL-8 before PCI between two groups ( P >0.05).The levels of NT-proBNP,IL-8 on 8h,24h,3d after PCI in rhBNP group were significantly lower than those in control group ( P <0.05). The incidences of postoperative myocardial injury in rhBNP group were significantly lower than those in control group ( P <0.05).Conclusion The administration of rhBNP before selective PCI may have a certain protective effects on postoperative myocardial injury by inhibiting activation of the sympathetic nerve -endocrine system and influencing inflammatory factors .