CAJ | 학술논문

目的：通过比较急性心肌梗死患者急诊经皮冠状动脉介入（ PCI）术中再灌注与无复流后脑钠肽前体（ NT-proB-NP）水平的变化，探讨NT-proBNP与无复流现象发生的相关性。方法选择116例急性心肌梗死行急诊PCI的患者为研究对象。急性心肌梗死患者根据PCI术中TIMI血流分级情况分为再灌注组（79例， TIMI＞2级），无复流组（37例， TIMI≤2级）。术前及术后24 h检测NT-proBNP水平，入院即刻及术后1h记录其心电图，计算ST段回降幅度（ STR）。结果（1）再灌注组术前NT-proBNP水平明显低于无复流组（P＜0．01）；再灌注组术后24 h NT-proBNP水平较术前明显下降（P＜0.05）；无复流组术后24 h NT-proBNP水平较术前无明显变化（P＞0．05）；再灌注组术后24 h NT-proBNP水平较无复流组明显下降（P＜0．01）。（2）再灌注组ST段迅速回落者所占百分比明显高于无复流组（P＜0．01）；（3）无复流组30 d内心血管事件的发生率显著高于再灌注组（P＜0．01）。结论 NT-proBNP水平升高是心肌组织灌注不足的体现，可较好的预测无复流现象的发生；心电图ST段回降幅度可作为灌注不良的指标之一；无复流增加30 d内心血管事件的再发生率。
목적：통과비교급성심기경사환자급진경피관상동맥개입（ PCI）술중재관주여무복류후뇌납태전체（ NT-proB-NP）수평적변화，탐토NT-proBNP여무복류현상발생적상관성。방법선택116례급성심기경사행급진PCI적환자위연구대상。급성심기경사환자근거PCI술중TIMI혈류분급정황분위재관주조（79례， TIMI＞2급），무복류조（37례， TIMI≤2급）。술전급술후24 h검측NT-proBNP수평，입원즉각급술후1h기록기심전도，계산ST단회강폭도（ STR）。결과（1）재관주조술전NT-proBNP수평명현저우무복류조（P＜0．01）；재관주조술후24 h NT-proBNP수평교술전명현하강（P＜0.05）；무복류조술후24 h NT-proBNP수평교술전무명현변화（P＞0．05）；재관주조술후24 h NT-proBNP수평교무복류조명현하강（P＜0．01）。（2）재관주조ST단신속회락자소점백분비명현고우무복류조（P＜0．01）；（3）무복류조30 d내심혈관사건적발생솔현저고우재관주조（P＜0．01）。결론 NT-proBNP수평승고시심기조직관주불족적체현，가교호적예측무복류현상적발생；심전도ST단회강폭도가작위관주불량적지표지일；무복류증가30 d내심혈관사건적재발생솔。
Objective To explore the relationship between serum NT-proBNP ( NT-pro brain natriuretic peptide ) and no-re-flow in patients with acute myocardial infarction , by comparing changes in the levels of NT-proBNP between the reperfusion group and the no-reflow group.Methods One hundred and sixteen patients (aged 59.3 ±17.2 years) with acute myocardial infarction undergo-ing emergent percutaneous coronary intervention were chosen as research subjects .In accordance with Thrombolysis In Myocardial In-farction (TIMI) blood flow grading method, the patients with acute myocardial infarction were divided into the reperfusion group (79 ca-ses, TIMI>grade 2)and the no-reflow group(37 cases, TIMI≤grade 2).Levels of NT-proBNP were detected 24 hours before and after admission into the hospital .ECG was monitored the moment before admission and 1 hour after PCI , and then ST-segment resolution (STR)was calculated.Differences in the above data were compared between the reperfusion group and the no -reflow group to see if there was statistical significance .Results (1)The level of serum NT-proBNP in the reperfusion group was significantly lower than that of the no-reflow group, with statistical significance(P<0.01).The level of serum NT-proBNP in the reperfusion group was obviously lower than that before PCI(P<0.05).No significant changes could be noted in the level of NT-proBNP 24 hours after PCI for the no-reflow group(P<0.05).The level of NT-proBNP in the reperfusion group 24 hours after PCI was not significantly decreased , as com-pared with that of the no-reflow group, with statistical significance(P<0.01).(2)The percentage of STR for the reperfusion group was obviously higher than that of the no-reflow group, also with statistical significance (P<0.01).(3)Incidence of cardiovascular events within one month for the no-reflow group was significantly higher than that of the reperfusion group , and statistical significance could be noted, when comparisons were made between them (P<0.01).Conclusion NT-proBNP was a manifestation of insufficient myocardi-um perfusion, which could well predict the occurrence of no-reflow.STR could be used as one of the indexes of poor perfusion , and no-reflow could increase the incidence of cardiovascular events within 1 month.