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目的为了探讨首次急性前壁ST段抬高心肌梗死者在不同再灌注情况下血浆脑钠肽和左室重构的关系。方法根据不同再灌注情况将56例患者分为3组:早期再灌注成功组、晚期再灌注成功组及再灌注失败组,各组于持续胸痛后准24小时、1个月测定血浆脑钠肽水平,于发病后24~72小时、1个月行超声心动图检查,测量左室舒张末容量、左室收缩末容量、左室射血分数,并通过计算得左室舒张末容量指数、左室收缩末容量指数,并获得1个月间的变量值。结果首次急性前壁ST段抬高心肌梗死者发病后24~72小时的血浆BNP水平高于正常对照组,晚期再灌注组及再灌注失败组高于早期再灌注组,而前两者无明显差异;发病后1个月时的BNP,再灌注失败组高于晚期再灌注组高于早期再灌注组。首次急性前壁ST段抬高心肌梗死者均发生近期左室重构,其程度与再灌注的情况相关,再灌注失败组重于晚期再灌注组重于早期再灌注组。首次急性前壁ST段抬高心梗后BNP水平与LVEDVI、LVESVI的变量值呈正相关,LVEF的变量值呈负相关,近期左室重构程度与发病后24~72小时的BNP值相关性大于发病后1个月的BNP值。结论首次急性前壁ST段抬高心肌梗死后血浆BNP水平与左室重构的程度均受再灌注情况的影响;血浆BNP与左室重构程度正相关,与左室收缩功能负相关。BNP是评价急性前壁ST段抬高心肌梗死后左室重构的生化指标。
Objective To investigate the relationship between plasma brain natriuretic peptide and left ventricular remodeling in patients with acute myocardial infarction with anterior wall ST segment under different conditions of reperfusion. Methods According to the different reperfusion conditions, 56 patients were divided into three groups: the early reperfusion success group, the late reperfusion success group and the reperfusion failure group. The patients were divided into three groups: 24 hours, 1 month after continuous chest pain, Level, left ventricular end-diastolic volume, left ventricular end-systolic volume and left ventricular ejection fraction were measured at 24 to 72 hours and 1 month after onset. Echocardiography was performed to calculate left ventricular end-diastolic volume index Ventricular end-systolic volume index, and variable values obtained for 1 month. Results The plasma levels of BNP in patients with acute ST-segment elevation myocardial infarction at 24-72 hours after onset were higher than those in the normal control group, those in the late reperfusion group and the reperfusion failure group were higher than those in the early reperfusion group, but the former two had no significant Differences; 1 month after onset of BNP, reperfusion failure group was higher than the late reperfusion group than the early reperfusion group. The first acute anterior ST-segment elevation myocardial infarction occurred in patients with recent LV remodeling, the extent and reperfusion related to the situation, the reperfusion failure group than in the late reperfusion group was heavier than the early reperfusion group. The level of BNP in the first acute ST-segment elevation myocardial infarction was positively correlated with the values of LVEDVI and LVESVI, and negatively correlated with the values of LVEF. The recent correlation between left ventricular remodeling and the BNP level at 24-72 hours after onset BNP value at 1 month after onset. Conclusions The plasma levels of BNP and left ventricular remodeling after the first acute anterior ST-segment elevation myocardial infarction are both affected by the reperfusion. Plasma BNP is positively correlated with left ventricular remodeling and negatively correlated with left ventricular systolic function. BNP is a biochemical marker of left ventricular remodeling after acute ST-segment elevation myocardial infarction.