脑钠肽前体在急性心肌梗死患者急诊经皮冠状动脉介入术中无复流的相关性探讨

摘要

Objective To explore the relationship between serum NT-proBNP ( NT-pro brain natriuretic peptide ) and no-re-flow in patients with acute myocardial infarction , by comparing changes in the levels of NT-proBNP between the reperfusion group and the no-reflow group.Methods One hundred and sixteen patients (aged 59.3 ±17.2 years) with acute myocardial infarction undergo-ing emergent percutaneous coronary intervention were chosen as research subjects .In accordance with Thrombolysis In Myocardial In-farction (TIMI) blood flow grading method, the patients with acute myocardial infarction were divided into the reperfusion group (79 ca-ses, TIMI>grade 2)and the no-reflow group(37 cases, TIMI≤grade 2).Levels of NT-proBNP were detected 24 hours before and after admission into the hospital .ECG was monitored the moment before admission and 1 hour after PCI , and then ST-segment resolution (STR)was calculated.Differences in the above data were compared between the reperfusion group and the no -reflow group to see if there was statistical significance .Results (1)The level of serum NT-proBNP in the reperfusion group was significantly lower than that of the no-reflow group, with statistical significance(P<0.01).The level of serum NT-proBNP in the reperfusion group was obviously lower than that before PCI(P<0.05).No significant changes could be noted in the level of NT-proBNP 24 hours after PCI for the no-reflow group(P<0.05).The level of NT-proBNP in the reperfusion group 24 hours after PCI was not significantly decreased , as com-pared with that of the no-reflow group, with statistical significance(P<0.01).(2)The percentage of STR for the reperfusion group was obviously higher than that of the no-reflow group, also with statistical significance (P<0.01).(3)Incidence of cardiovascular events within one month for the no-reflow group was significantly higher than that of the reperfusion group , and statistical significance could be noted, when comparisons were made between them (P<0.01).Conclusion NT-proBNP was a manifestation of insufficient myocardi-um perfusion, which could well predict the occurrence of no-reflow.STR could be used as one of the indexes of poor perfusion , and no-reflow could increase the incidence of cardiovascular events within 1 month.%目的：通过比较急性心肌梗死患者急诊经皮冠状动脉介入（ PCI）术中再灌注与无复流后脑钠肽前体（ NT-proB-NP）水平的变化，探讨NT-proBNP与无复流现象发生的相关性。方法选择116例急性心肌梗死行急诊PCI的患者为研究对象。急性心肌梗死患者根据PCI术中TIMI血流分级情况分为再灌注组（79例， TIMI＞2级），无复流组（37例， TIMI≤2级）。术前及术后24 h检测NT-proBNP水平，入院即刻及术后1h记录其心电图，计算ST段回降幅度（ STR）。结果（1）再灌注组术前NT-proBNP水平明显低于无复流组（P＜0．01）；再灌注组术后24 h NT-proBNP水平较术前明显下降（P＜0.05）；无复流组术后24 h NT-proBNP水平较术前无明显变化（P＞0．05）；再灌注组术后24 h NT-proBNP水平较无复流组明显下降（P＜0．01）。（2）再灌注组ST段迅速回落者所占百分比明显高于无复流组（P＜0．01）；（3）无复流组30 d内心血管事件的发生率显著高于再灌注组（P＜0．01）。结论 NT-proBNP水平升高是心肌组织灌注不足的体现，可较好的预测无复流现象的发生；心电图ST段回降幅度可作为灌注不良的指标之一；无复流增加30 d内心血管事件的再发生率。