溶栓治疗对急性心肌梗死后血浆脑钠肽水平及预后的影响(1)
【摘要】 目的 观察氨基末端B型脑钠肽(NT-proBNP)水平在急性心肌梗死(AMI)患者溶栓前后的变化以及临床预后的影响， 探讨其临床价值。方法 60例符合溶栓条件的急性心肌梗死患者， 进行规范化静脉溶栓治疗， 根据溶栓是否成功将患者分为溶栓成功组(40例)和溶栓未成功组(20例)， 记录1个月时的主要心血管事件， 分别在入院即时和入院后12、24、48 h及14 d测定患者血浆NT-proBNP水平。同时给予抗血小板、抗凝、扩张冠脉、稳定斑块、营养心肌、处理并发症等治疗。结果 溶栓前两组NT-proBNP水平差异无统计学意义(P>0.05)。溶栓后溶栓成功组NT-proBNP水平明显低于溶栓未成功组， 差异有统计学意义(P<0.01)。3个月内主要心血管事件的发生率明显低于溶栓未成功组， 差异有统计学意义(P<0.05)。结论 再灌注治疗能够显著降低急性心肌梗死患者血浆NT-proBNP水平， 减少心血管事件的发生。
【关键词】 溶栓；氨基末端B型脑钠肽；心血管事件；急性心肌梗死
DOI：10.14163/j.cnki.11-5547/r.2015.24.012
【Abstract】 Objective To observe changes of amino-terminal pro B-type natriuretic peptide (NT-proBNP) levels in acute myocardial infarction (AMI) patients before and after thrombolysis， and influence on clinical prognosis， and to investigate its clinical value. Methods There were 60 acute myocardial infarction patients receiving conventional intravenous thrombolysis treatment， and they were divided by successful thrombolysis into successful thrombolysis group (40 cases) and non-successful thrombolysis group (20 cases). Main cardiovascular events in 1 month were recorded. Their plasma NT-proBNP levels were detected during admission， and in 12， 24， 48 h， and 14 d after admission. The patients also received antiplatelet， anticoagulation， coronary artery dilation， plaque stabilization， myocardial nutrition， and complications management for treatment. Results There was no statistically significant difference of NT-proBNP before thrombolysis between the two groups (P>0.05). After thrombolysis， the successful thrombolysis group had obviously lower NT-proBNP level than the non-successful thrombolysis group， and their difference had statistical significance (P<0.01). The successful thrombolysis group had lower incidence of main cardiovascular events within 3 months than the non-successful thrombolysis group， and their difference had statistical significance (P<0.05). Conclusion Reperfusion therapy can remarkably reduce plasma NT-proBNP level in acute myocardial infarction patients， and reduce incidence of cardiovascular events.
【Key words】 Thrombolysis； Amino-terminal pro B-type natriuretic peptide； Cardiovascular events； Acute myocardial infarction
急性心肌梗死的发生是斑块破裂、血栓形成从而导致相关冠状动脉致完全闭塞引起的一系列临床病理生理性改变。在我国基层医院静脉溶栓是治疗急性心肌梗死的主要措施， 早期行再灌注治疗是降低心血管事件、防止左室重构、保护心功能的有效方法。BNP是主要由心室分泌的一种肽类激素， 心肌梗死后BNP升高， 提示梗死面积大， 预后不佳， 心功能差。而降低BNP水平， 可以从一定程度上改善AMI患者预后， 本研究目的是探讨瑞替普酶溶栓治疗对AMI患者血浆NT-proBNP及心血管事件的影响。现报告如下。
1 资料与方法
1. 1 一般资料 选择60例2013～2014年于本院CCU病房住院并接受溶栓治疗急性ST段抬高性AMI患者， 年龄35～70岁， 其中， 男40例， 女20例， 下后壁心肌梗死36例， 前间壁心肌梗死10例， 广泛前壁心肌梗死14例。根据溶栓是否成功， 将患者分为溶栓成功组(40例)和溶栓未成功组(20例)。两组一般资料比较差异无统计学意义(P>0.05)， 具有可比性。急性心肌梗死的诊断标准：胸痛持续≥30 min， 心电图ST段≥2个肢体导联抬高≥0.1 mV， 或在相邻2个或2个以上胸前导联ST段抬高≥0.2 mV或新出现的左束支传导阻滞的患者。距离发病在6 h以内；经家属同意并签署同意书。除外近期活动性内脏出血、脑卒中、出血倾向、主动脉夹层、严重高血压[>180/110 mm Hg(1 mm Hg=0.133 kPa)]和严重肝肾功能障碍等[1]。, 百拇医药(王磊)
【关键词】 溶栓；氨基末端B型脑钠肽；心血管事件；急性心肌梗死
DOI：10.14163/j.cnki.11-5547/r.2015.24.012
【Abstract】 Objective To observe changes of amino-terminal pro B-type natriuretic peptide (NT-proBNP) levels in acute myocardial infarction (AMI) patients before and after thrombolysis， and influence on clinical prognosis， and to investigate its clinical value. Methods There were 60 acute myocardial infarction patients receiving conventional intravenous thrombolysis treatment， and they were divided by successful thrombolysis into successful thrombolysis group (40 cases) and non-successful thrombolysis group (20 cases). Main cardiovascular events in 1 month were recorded. Their plasma NT-proBNP levels were detected during admission， and in 12， 24， 48 h， and 14 d after admission. The patients also received antiplatelet， anticoagulation， coronary artery dilation， plaque stabilization， myocardial nutrition， and complications management for treatment. Results There was no statistically significant difference of NT-proBNP before thrombolysis between the two groups (P>0.05). After thrombolysis， the successful thrombolysis group had obviously lower NT-proBNP level than the non-successful thrombolysis group， and their difference had statistical significance (P<0.01). The successful thrombolysis group had lower incidence of main cardiovascular events within 3 months than the non-successful thrombolysis group， and their difference had statistical significance (P<0.05). Conclusion Reperfusion therapy can remarkably reduce plasma NT-proBNP level in acute myocardial infarction patients， and reduce incidence of cardiovascular events.
【Key words】 Thrombolysis； Amino-terminal pro B-type natriuretic peptide； Cardiovascular events； Acute myocardial infarction
急性心肌梗死的发生是斑块破裂、血栓形成从而导致相关冠状动脉致完全闭塞引起的一系列临床病理生理性改变。在我国基层医院静脉溶栓是治疗急性心肌梗死的主要措施， 早期行再灌注治疗是降低心血管事件、防止左室重构、保护心功能的有效方法。BNP是主要由心室分泌的一种肽类激素， 心肌梗死后BNP升高， 提示梗死面积大， 预后不佳， 心功能差。而降低BNP水平， 可以从一定程度上改善AMI患者预后， 本研究目的是探讨瑞替普酶溶栓治疗对AMI患者血浆NT-proBNP及心血管事件的影响。现报告如下。
1 资料与方法
1. 1 一般资料 选择60例2013～2014年于本院CCU病房住院并接受溶栓治疗急性ST段抬高性AMI患者， 年龄35～70岁， 其中， 男40例， 女20例， 下后壁心肌梗死36例， 前间壁心肌梗死10例， 广泛前壁心肌梗死14例。根据溶栓是否成功， 将患者分为溶栓成功组(40例)和溶栓未成功组(20例)。两组一般资料比较差异无统计学意义(P>0.05)， 具有可比性。急性心肌梗死的诊断标准：胸痛持续≥30 min， 心电图ST段≥2个肢体导联抬高≥0.1 mV， 或在相邻2个或2个以上胸前导联ST段抬高≥0.2 mV或新出现的左束支传导阻滞的患者。距离发病在6 h以内；经家属同意并签署同意书。除外近期活动性内脏出血、脑卒中、出血倾向、主动脉夹层、严重高血压[>180/110 mm Hg(1 mm Hg=0.133 kPa)]和严重肝肾功能障碍等[1]。, 百拇医药(王磊)