CAJ | 학술논문

目的：探讨冠脉介入治疗（PCI）对急性左室下壁和前壁心肌梗死患者血浆脑利钠肽（BNP）、醛固酮（Ald）水平及近期预后的影响。方法：分析治疗前212例急性下壁（140例）、前壁（72例）心肌梗死患者血浆BNP、Ald水平及与冠脉病变的关系；比较两组患者直接、延迟PCI治疗后血浆BNP、Ald水平的变化及对近期预后的影响。结果：PCI治疗前，与急性下壁梗死组比较，急性前壁梗死组患者血浆 BNP[（642.06±235.08） ng／L比（856.54±223.50） ng／L]、Ald[（50.26±5.23） ng／dl比（88.34±8.52） ng／dl ]水平、冠脉狭窄程度[（82.28±7.65）％比（90.64±7.54）％]及3支病变发生率（22.52％比39.66％）均明显升高（P均＜0.05）；直接和延迟PCI治疗后，血浆BNP、Ald水平明显下降（P均＜0.01），且直接PCI组较延迟PCI组血浆BNP[急性下壁梗死组：（216.93±119.86） ng／L比（453.75±107.54） ng／L ，急性前壁梗死组：（245.754±121.52） ng／L比（483.04±164.65） ng／L]、Ald[急性下壁梗死组：（40.09±6.55） ng／dl比（45.34±8.15） ng／dl ，急性前壁梗死组：（43.65±3.50） ng／dl比（50.43±9.21） ng／dl]水平下降更显著（P均＜0.01）；未行PCI治疗的患者近期死亡发生率明显高于行直接 PCI及延迟PCI治疗的患者（11.63％比2.78％比3.28％，P均＜0.05）。结论：急性前壁心肌梗死患者血浆BNP、Ald水平高，冠脉病变严重；直接PCI较延迟PCI治疗血浆BNP、Ald浓度下降幅度更大，未行PCI治疗的患者死亡率较高。
목적：탐토관맥개입치료（PCI）대급성좌실하벽화전벽심기경사환자혈장뇌리납태（BNP）、철고동（Ald）수평급근기예후적영향。방법：분석치료전212례급성하벽（140례）、전벽（72례）심기경사환자혈장BNP、Ald수평급여관맥병변적관계；비교량조환자직접、연지PCI치료후혈장BNP、Ald수평적변화급대근기예후적영향。결과：PCI치료전，여급성하벽경사조비교，급성전벽경사조환자혈장 BNP[（642.06±235.08） ng／L비（856.54±223.50） ng／L]、Ald[（50.26±5.23） ng／dl비（88.34±8.52） ng／dl ]수평、관맥협착정도[（82.28±7.65）％비（90.64±7.54）％]급3지병변발생솔（22.52％비39.66％）균명현승고（P균＜0.05）；직접화연지PCI치료후，혈장BNP、Ald수평명현하강（P균＜0.01），차직접PCI조교연지PCI조혈장BNP[급성하벽경사조：（216.93±119.86） ng／L비（453.75±107.54） ng／L ，급성전벽경사조：（245.754±121.52） ng／L비（483.04±164.65） ng／L]、Ald[급성하벽경사조：（40.09±6.55） ng／dl비（45.34±8.15） ng／dl ，급성전벽경사조：（43.65±3.50） ng／dl비（50.43±9.21） ng／dl]수평하강경현저（P균＜0.01）；미행PCI치료적환자근기사망발생솔명현고우행직접 PCI급연지PCI치료적환자（11.63％비2.78％비3.28％，P균＜0.05）。결론：급성전벽심기경사환자혈장BNP、Ald수평고，관맥병변엄중；직접PCI교연지PCI치료혈장BNP、Ald농도하강폭도경대，미행PCI치료적환자사망솔교고。
Objective:To explore the influence of percutaneous coronary intervention (PCI) on plasma levels of brain natri‐uretic peptide (BNP) and aldosterone (Ald) and short‐term prognosis in patients with acute left ventricular inferior and an‐terior wall myocardial infarction .Methods:A total of 212 patients were divided into acute inferior myocardial infarction (AIMI) group (n=140) and acute anterior myocardial infarction (AAMI) group (n=72) .Relationship among plasma lev‐els of BNP and Ald and coronary artery disease were analyzed in two groups .Changes of plasma levels of BNP and Ald after direct/delayed PCI and influence of PCI on short‐term prognosis were compared between two groups .Results:Compared with AIMI group before PCI ,there were significant rise in plasma levels of BNP [ (642.06 ± 235.08) ng/L vs .(856.54 ± 223.50) ng/L] and Ald [(50.26 ± 5.23) ng/dl vs .(88.34 ± 8.52) ng/dl] ,extent of coronary stenosis [(82.28 ± 7.65)%vs .(90.64 ± 7.54)% ] and incidence rate of triple‐vessel coronary disease (22.52% vs .39.66% ) in AAMI group , P<0.05 all;plasma levels of BNP and Ald significantly reduced in both groups after direct /delayed PCI (P<0.01 both) ,com‐pared with delayed PCI group ,there were significant reductions in plasma levels of BNP [AIMI group:(453.75 ± 107.54) ng/L vs .(216.93 ± 119.86) ng/L ,AAMI group:(483.04 ± 164.65) ng/L vs .(245.754 ± 121.52) ng/L] and Ald [AIMI group:(45.34 ± 8.15) ng/dl vs .(40.09 ± 6.55) ng/dl ,AAMI group:(50.43 ± 9.21) ng/dl vs .(43.65 ± 3.50) ng/dl] in direct PCI group , P<0.01 all;short‐term mortality rate of patients not undergoing PCI was significantly higher than those of patients undergoing direct PCI and delayed PCI (11.63% vs .2.78% vs .3.28% , P<0.05 both ) .Conclusion:Plasma levels of BNP and Ald are higher and coronary disease is more severe in AAMI patients ;compared with delayed PCI ,plas‐ma concentrations of BNP and Ald possess higher decreasing extent after undergoing direct PCI ;patients not receiving PCI possess higher mortality rate .