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目的观察急性心肌梗死(AMI)后血B-型尿钠肽(BNP)水平升高的特点,探讨AMI后BNP水平升高的意义。方法连续入选住院AMI患者230例及正常对照111例进行BNP测定。按照首次或再发AMI后ST段抬高型或非ST段抬高型AMI(STEMI或NSTEMI)、不同部位AMI、不同冠状动脉病变、不同梗死相关血管(IRA)、IRA不同TIMI血流和是否急诊经皮冠状动脉介入治疗(PCI)进行分组,采用Student-t检验和ANOVA分析对比各组间BNP水平和心功能相关指标的差异。结果AMI后2~7天,患者BNP水平显著升高(P<0.01),平均为(553.7±735.1)ng/L,是对照组的21倍;与首次AMI组对比,再发组左室射血分数(LVEF)显著降低(P<0.01),左室舒张末径(LVEDd)、BNP水平和LnBNP均显著升高(P均<0.01);与无显著狭窄病变AMI患者对比,单支、三支血管狭窄组的BNP水平显著为高(P均<0.05);IRA的TIMI血流0~1、2级组BNP水平均显著高于TIMI血流3级组(P均<0.01);与未急诊PCI组对比,急诊PCI组血肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)虽显著升高(P<0.05~0.01),然BNP水平显著降低(P<0.05)。结论AMI后,血BNP水平显著升高。以再发AMI、未行急诊PCI治疗和IRA血流TIMI0~2级者更高。急诊PCI可出现心肌酶升高,而BNP降低的矛盾现象。
Objective To observe the characteristics of elevated blood B-type natriuretic peptide (BNP) after acute myocardial infarction (AMI) and to explore the significance of elevated BNP levels after AMI. Methods A total of 230 hospitalized AMI patients and 111 normal controls were enrolled in this study. According to AMI (STEMI or NSTEMI), AMI at different sites, different coronary artery disease, different infarct-related blood vessels (IRA), IRA different TIMI blood flow and whether or not AMI after ST-segment elevation AMI (STEMI or NSTEMI) Emergency percutaneous coronary intervention (PCI) were divided into groups. Student’s t-test and ANOVA analysis were used to compare the differences of BNP levels and cardiac function-related indexes between groups. Results The levels of BNP in patients with AMI were significantly increased (P <0.01) after 2 to 7 days of AMI, with an average of (553.7 ± 735.1) ng / L, which was 21 times of that of the control group (P <0.01), LVEDd, BNP and LnBNP were significantly increased (all P <0.01). Compared with AMI patients without significant stenosis, the levels of LVEF, BNP levels in vessel stenosis group were significantly higher than those in TIMI group (all P <0.05); BNP levels in IRA group were significantly higher than those in TIMI group 3 (all P <0.01) Compared with the emergency PCI group, the levels of CK-MB and TnT in the emergency PCI group were significantly increased (P <0.05-0.01), while the levels of BNP were significantly decreased (P <0.05) . Conclusion After AMI, blood BNP levels increased significantly. To relapse AMI, no emergency PCI and IRA blood flow TIMI0 ~ 2 were higher. Emergency PCI can occur elevated myocardial enzymes, and reduce the paradox of BNP phenomenon.