| 摘要: |
| 目的 探讨急性右心室心肌梗死并左心室下壁、前壁梗死直接和延迟经皮冠状动脉介入(PCI)治疗对血浆脑利钠肽(BNP)水平及心室重构的影响。方法 急性右心室心肌梗死并左心室下壁、前壁梗死患者207例。根据梗死部位分为急性右心室梗死并左心室下壁梗死组（n=159）和急性右心室梗死并左心室前壁梗死组(n=48),比较2组患者PCI治疗前血浆BNP水平、心肌酶、血流动力学指标及冠状动脉病变特点；根据是否行PCI及PCI治疗的时机将两组再分别分为未行PCI组、直接PCI组和延迟PCI组,比较组间死亡情况的差异及直接和延迟PCI治疗前后血浆BNP水平、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)的变化。结果 急性右心室心肌梗死并左心室前壁梗死组PCI治疗前血浆BNP水平、肌酸激酶(CK) 峰值、肌酸激酶同工酶(CK-MB)峰值、肺动脉收缩压、梗死相关冠状动脉狭窄程度及2支病变发生率均高于急性右心室心肌梗死并左心室下壁梗死组,差异有统计学意义(P<0.05)。直接和延迟PCI治疗后均能使血浆BNP水平及LVEDd较术前下降(P<0.05),但直接PCI治疗术后血浆BNP水平更低、LVEDd改善更明显(P<0.05)。未行PCI治疗的患者死亡发生率明显高于行直接PCI及延迟PCI治疗的患者,差异有统计学意义(P<0.05)。结论 急性右心室心肌梗死并左心室前壁梗死患者血浆BNP水平高,梗死相关冠状动脉病变严重；直接PCI治疗后心室重构改善明显,血浆BNP水平下降显著。 |
| 关键词: 心肌梗死 经皮冠状动脉介入治疗 脑利钠肽 心室重构 |
| DOI：10.3724/SP.J.1008.2012.00637 |
| 投稿时间：2011-06-15修订日期：2012-03-29 |
| 基金项目:福建省教育厅科技项目A类(JA09278). |
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| Impact of percutaneous coronary intervention on plasma brain natriuretic peptide levels and ventricular remodeling in patients with acute right ventricular myocardial infarction combined with left ventricular inferior wall or anterior wall myocardial infa |
| DENG Shao-xiong1*,GUO Nan-ou2,ZHENG Yuan1,LIN Pei-huang3,HUANG Wen-sen1 |
(1. Department of Internal Medicine, Quanzhou Medical College, Quanzhou 362000, Fujian, China
2. Department of Cardiology, First Hospital of Quanzhou, Fujian Medical University, Quanzhou 362000, Fujian, China
3. Department of Physiology, Quanzhou Medical College, Quanzhou 362000, Fujian, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the impact of percutaneous coronary intervention (PCI) on plasma brain natriuretic peptide (BNP) levels and ventricular remodeling in patients with acute right ventricular myocardial infarction (ARVMI) combined with left ventricular inferior wall myocardial infarction (LVIWMI) or anterior wall myocardial infarction (LVAWMI). Methods Totally 207 patients with ARVMI combined with LVAWMI or LVIWMI were included in the present study. The patients were divided into two groups: ARVMI plus LVIWMI (n=159) and ARVMI plus LVAWMI(n=48). The plasma BNP levels, myocardium enzyme, hemodynamic indices and coronary artery disease were compared between the two groups. The plasma BNP level, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDd) were observed in patients before and after primary PCI or delayed PCI treatment and in those receiving no PCI. Results We found that the plasma BNP level, CK and CK-MB peak value, pulmonary artery systolic pressure, degree of infarct-related coronary artery and incidence of 2-branch involvement in ARVMI plus LVAWMI group were significantly higher than those in the ARVMI plus LVIWMI group (P<0.05). The plasma BNP levels and LVEDd were significantly decreased in patients after treatment with primary PCI or delayed PCI (P<0.05), and the plasma BNP level was significantly lower and improvement of LVEDd was significantly greater in patients receiving primary PCI(P<0.05). Patients receiving no PCI treatment had a significantly higher mortality compared with those receiving primary or delayed PCI(P<0.05). ConclusionPatients with ARVMI plus LVAWMI have higher level of BNP and more severe coronary symptoms. There are noticeable improvement of ventricular remodeling in patients receiving primary PCI, and they also have greatly decreased plasma BNP level. |
| Key words: myocardial infarction percutaneous coronary intervention brain natriuretic peptide ventricular remodeling |
