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目的探讨不同类型急性心肌梗死B型尿钠肽(BNP)水平及经皮冠状动脉介入(PCI)治疗前后BNP的变化。方法选取2010年7月—2011年7年于邢台市第三医院心内科住院并诊断为急性心肌梗死且行PCI治疗患者100例,分为急性ST段抬高心肌梗死组(A组)55例与急性非ST段抬高心肌梗死组(B组)45例。记录每位患者入院时及PCI术后48 hBNP水平,分析急性心肌梗死类型与BNP的关系、BNP与冠脉病变程度相关性以及BNP水平与急性心肌梗死患者6个月内发生心血管事件的关系。结果 A组BNP水平高于B组(108.8±44.3 vs 83.1±28.9 pg/ml,P<0.01)。A、B 2组术后BNP水平明显低于术前BNP,差异有统计学意义(108.8±44.3 vs 78.7±27.7,P=0.000;83.1±28.9 vs 65.1±20.9,P<0.01)。Gensini积分与术前BNP水平正相关(r=0.484,P<0.05)。术后随着BNP水平增高,心血管事件发生率有增高趋势,BNP>85.1 pg/ml组心血管事件发生率显著高于其他组并与BNP≤55.0 pg/ml组比较,差异有统计学意义(χ2=6.04,P<0.05)。结论在排除心衰因素后,冠状动脉病变程度与BNP水平呈正相关,急性心肌梗死缺血改善后BNP水平明显降低。术后BNP水平越高,6个月内心血管事件发生率越高。测定外周血BNP水平对评价冠状脉动脉病变程度及判断预后有重要参考价值。
Objective To investigate the changes of BNP in patients with different types of acute myocardial infarction before and after percutaneous coronary intervention (PCI). Methods A total of 100 patients with acute myocardial infarction who were hospitalized in Department of Cardiology, Third Hospital of Xingtai City from July 2010 to July 2011 were enrolled in this study. The patients were divided into acute ST-segment elevation myocardial infarction (A group) and 55 Acute non-ST-elevation myocardial infarction group (B group) 45 cases. The level of BNP was recorded at admission and at 48 hours after PCI in each patient. The relationship between the type of acute myocardial infarction and BNP, the correlation between BNP and coronary lesion and the incidence of cardiovascular events within 6 months in patients with acute myocardial infarction . Results The level of BNP in group A was higher than that in group B (108.8 ± 44.3 vs 83.1 ± 28.9 pg / ml, P <0.01). The level of BNP in group A and group B after operation was significantly lower than that before operation (108.8 ± 44.3 vs 78.7 ± 27.7, P = 0.000; 83.1 ± 28.9 vs 65.1 ± 20.9, P <0.01). Gensini score was positively correlated with preoperative BNP level (r = 0.484, P <0.05). The incidence of cardiovascular events increased with the increase of BNP level after PCI. The incidence of cardiovascular events in BNP> 85.1 pg / ml group was significantly higher than that in other groups and was significantly lower than that in BNP≤55.0 pg / ml group (χ2 = 6.04, P <0.05). Conclusions After excluding heart failure, the degree of coronary artery disease is positively correlated with BNP level. BNP level in ischemic myocardium with acute myocardial infarction is significantly lower. The higher the level of postoperative BNP, the higher the incidence of cardiovascular events within 6 months. Measurement of peripheral blood BNP levels for the evaluation of coronary artery disease severity and prognosis of important reference value.