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目的:探讨急性下壁心肌梗死(AIMI)患者伴或不伴有右心肌梗死与血浆B型利钠肽(BNP)水平的相关性。方法:入选AIMI患者213例,依据临床表现、心电图和冠状动脉造影将213例AIMI患者分为伴有右心室梗死组(A组)和单纯AIMI组(B组),另选同时期住院冠状动脉造影正常者98例作正常对照组。测定各组及AIMI中不同病变部位者BNP水平,并对不同BNP水平患者进行住院期间、30d、3个月死亡事件及主要心脏不良事件的临床观察。结果:A组血浆BNP水平明显高于B组(P<0.01)。右冠状动脉近段和中段病变患者血浆BNP水平显著高于左回旋支病变患者(P<0.01)。AIMI患者中血浆BNP水平升高独立于各因素预测30d和3个月病死率及心脏不良事件发生率(r=0.7010,95%CI:<0.01～0.615,P<0.01)。结论:BNP水平可能对AIMI伴右心室梗死有预测作用。
Objective: To investigate the relationship between acute myocardial infarction (AIMI) patients with or without right myocardial infarction and plasma B-type natriuretic peptide (BNP) levels. Methods: A total of 213 patients with AIMI were enrolled in this study. A total of 213 patients with AIMI were divided into group A (A) and group AIMI (group B) according to clinical manifestations, electrocardiogram (ECG) and coronary angiography. Normal contrast 98 cases of normal control group. The levels of BNP in different groups and AIMI were measured, and the clinical observation of deaths and major adverse cardiac events during hospitalization, 30d and 3 months in patients with different BNP levels were performed. Results: Plasma BNP level in group A was significantly higher than that in group B (P <0.01). Plasma BNP levels in patients with proximal and middle right coronary arteries were significantly higher than those with left circumflex coronary artery lesions (P <0.01). Plasma BNP levels in patients with AIMI independently predicted the 30-day and 3-month mortality and the incidence of adverse cardiac events independently of each other (r = 0.7010, 95% CI: <0.01-0.615, P <0.01). Conclusion: The level of BNP may predict AIMI with right ventricular infarction.