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急性心肌梗死患者血浆N末端B型利钠肽原水平与经皮冠状动脉介入术中无复流的关系
Preprocedural N-terminal B-type natriuretic peptide can predict the no-reflow phenomenon during percutaneous coronary intervention in patients with acute myocardial infarction

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DOI:
作者:
张志,许海涛,许文虎,刘紫东
ZHANG Zhi1, Xu Haitao2, Xu Wenhu1, Liu Zidong1
作者单位:
1.辽宁医学院附属第三医院心内科,2.锦州市中心医院心内科
1.Department of Cardiology, The Third Affiliated Hospital of Liaoning Medical University, 2. Department of Cardiology, Jinzhou Central Hospital
关键词:
急性心肌梗死；经皮冠状动脉介入；无复流；N末端B型利钠肽原
acute myocardial infarction; percutaneous coronary intervention; no-reflow; N-terminal B-type natriuretic peptide
摘要:
[摘要] 目的 探讨急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入（PCI）术前血浆N末端B型利钠肽原（NT-proBNP）水平与介入术中无复流的关系。方法 74例急性ST段抬高心肌梗死接受急诊PCI治疗的患者，按介入治疗术中有无发生无复流（梗死相关动脉前向血流≤ TIMI 2级）分为正常血流组和无复流组，分析所有患者的临床资料，并于介入治疗术前床旁检测血浆NT-proBNP、C-反应蛋白（CRP）及肌钙蛋白-I（cTnI）水平。结果 在74例患者中，有19例在PCI术中曾发生无复流现象，55例血流正常。两组在平均年龄、性别、体重指数、吸烟史、合并高血压及糖尿病、发病至球囊扩张时间等方面差异无统计学意义。无复流组术前血浆NT-proBNP水平明显高于正常血流组[（1163 ± 856）ng/L比（514 ± 472）ng/L，P ＜ 0.01]；cTnI高于正常血流组[（33.3±16.8）ng/L比（21.4±7.1）ng/L，P ＜ 0.05]。无复流组术后左室射血分数（EF）低于正常血流组[（50.1±8.8）%比（56.9±9.1）%， P ＜ 0.05]，住院天数增加（9.5±2.0天 比7.0±1.6天, P ＜ 0.05）。结论 急性心肌梗死患者急诊PCI术前血浆NT-proBNP水平增高与介入术中无复流发生率增加有关。
[Abstract] Objective The aim of this study was to assess the relation between preprocedural N-terminal B-type natriuretic peptide (NT-proBNP) and angiographic no-reflow phenomenon during percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction（STEMI）. Methods We investigated the baseline characteristics and measured preprocedural levels of plasma NT-proBNP、 CRP and cTnI in 74 consecutive patients with acute STEMI before PCI. Angiographic no-reflow during PCI was defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade ≤2. Results Baseline characteristics, including age、gender、body mass index、smoking、 hypertension、diabetes and time from chest pain onset, between the no-reflow (n = 19) and normal-reflow groups (n = 55) were similar. NT-proBNP was significantly higher in the no-reflow group than the normal reflow group (1163 ± 856 vs 514 ± 472 ng/L; P ＜ 0.01). Also, cTnI was higher in the no-reflow group than the normal-reflow group (33.3 ± 16.8 vs 21.4 ± 7.1 ng/L; P ＜ 0.05). Ejection Fraction of the no-reflow group was worse than that of the normal-reflow group after PCI [（50.1 ± 8.8）% vs （56.9 ± 9.1）%, P ＜ 0.05]，and the patients with no-reflow need longer time in hospital（9.5 ± 2.0d vs 7.0 ± 1.6d, P ＜ 0.05）。Conclusion Preprocedural NT-proBNP may be a strong predictor of the development of no-reflow phenomenon during PCI in patients with acute STEMI.

 

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