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目的探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)及溶栓治疗后血浆氨基末端脑利钠肽前体(NT-proBNP)水平变化趋势及对预后判断的价值。方法发病后24h内入院的ST段抬高型AMI患者188例,根据患者最终选择的治疗方式分为四组:A组(n=50):行急诊PCI治疗,住院期间第5～7d行第二次PCI治疗;B组(n=48):仅行急诊PCI治疗;C组(n=46):给予静脉溶栓治疗,住院期间第5～7d行择期PCI治疗;D组(n=44):仅给予静脉溶栓治疗。测量不同时间点患者血浆NT-proBNP水平。根据患者入院24hNT-proBNP值,将患者分为:0～299pg/ml组、300～899pg/ml组及≥900pg/ml组,记录三组患者住院期间、随访半年内及1年内的主要不良心脏事件(MACE)。对PCI术后NT-proBNP水平与随访1年时冠状动脉支架内再狭窄的关系进行了研究。结果四组患者入院24hNT-proBNP水平均达峰值,随后呈逐渐下降趋势。A、B两组比较,AMI后45d、半年、1年时NT-proBNP水平差异有统计学意义(P<0.05);C、D组与A、B组比较,入院后各时间点NT-proBNP水平均有统计学差异(P<0.05);C、D两组比较,AMI后第11d、随访第45d、半年及1年时NT-proBNP水平差异有统计学意义(P<0.05)。NT-proBNP水平0～299pg/ml、300～899pg/ml及≥900pg/ml三组患者住院期间、随访半年及1年时MACE发生率均呈递增趋势;其中0～299pg/ml组、300～899pg/ml组患者MACE发生率无统计学差异(P>0.05);而此两组与≥900pg/ml组比较,MACE发生率均有统计学差异(P<0.05)。随访1年时发生冠状动脉再狭窄患者各时间点NT-proBNP水平明显高于未再狭窄患者,其差异有统计学意义(P<0.05)。结论 NT-proBNP水平对预测急性心肌梗死患者PCI及溶栓治疗后近、中期预后及1年时冠状动脉再狭窄具有临床价值;急诊PCI及择期二次PCI对降低NT-proBNP水平优于溶栓治疗。
Objective To investigate the change trend of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level after percutaneous coronary intervention (PCI) and thrombolytic therapy in patients with acute myocardial infarction (AMI) and its prognostic value. Methods A total of 188 patients with ST-segment elevation AMI were enrolled in this study. The patients were divided into four groups according to the final choice of treatment: group A (n = 50): emergency PCI, days 5 to 7d Group C (n = 46): received intravenous thrombolytic therapy; patients undergoing elective PCI during the first 5 to 7 days of hospitalization; group D (n = 44) received PCI only during the second PCI period; group B ): Only intravenous thrombolytic therapy. Plasma NT-proBNP levels were measured at different time points. Patients were divided into 0 ~ 299pg / ml group, 300 ~ 899pg / ml group and ≥900pg / ml group according to the 24hNT-proBNP value of admission. The main adverse cardiac events were recorded during the hospitalization, Event (MACE). The relationship between the level of NT-proBNP after PCI and the degree of coronary stent restenosis at 1-year follow-up was studied. Results The four groups of patients reached the peak of 24hNT-proBNP peak, then showed a gradual downward trend. There were significant differences in NT-proBNP levels between the groups A and B at 45 days, 6 months and 1 year after AMI (P <0.05). Compared with groups A and B, NT-proBNP (P <0.05). There was significant difference in the levels of NT-proBNP between the two groups at the 11th day, the 45th day, the 6th and the 1th year after AMI (P <0.05). The incidence of MACE in patients with NT-proBNP levels of 0-299 pg / ml, 300-899 pg / ml and ≥900 pg / ml during hospitalization was gradually increased at 6 and 1 year follow-up. The incidence of MACE in 899pg / ml group had no significant difference (P> 0.05). However, the incidence of MACE in both groups was statistically different from that in ≥900pg / ml group (P <0.05). The level of NT-proBNP in patients with coronary artery restenosis at one-year follow-up was significantly higher than that in patients without restenosis (P <0.05). Conclusion The level of NT-proBNP has clinical value in predicting the prognosis of patients with acute myocardial infarction after PCI and thrombolytic therapy, and prognosis of coronary artery at 1 year. The reduction of NT-proBNP level in emergency PCI and elective PCI is superior to thrombolysis treatment.