2018 年第 12 期 第 13 卷

重组人脑利钠肽对老年ST段抬高型心肌梗死患者经皮冠状动脉介入术后心功能的影响

Effect of recombinant human brain natriuretic peptide on heart function in elderly ST-segment elevation myocardial infarction patients after percutaneous coronary intervention

作者：顾文娟张荣赵婷婷

英文作者：

单位：710002西安市第一医院心血管病五病区

英文单位：

关键词：ST段抬高型心肌梗死；重组人脑利钠肽；经皮冠状动脉介入；结缔组织生长因子；微小RNA-92a

英文关键词：

• 摘要：

• 【摘要】目的    探讨重组人脑利钠肽对老年ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后心功能的影响。方法    选取2012年3月至2016年3月在西安市第一医院接受急诊PCI治疗的老年STEMI患者83例，按照随机数字表法分为2组。2组患者PCI术后均接受常规治疗，观察组(41例)在常规治疗基础上给予重组人脑利钠肽治疗，对照组（42例）则给予等量0.9%氯化钠溶液。比较2组患者PCI术后临床症状及体征，监测患者入院3 d内心肌坏死标志物血清肌酸激酶同工酶和肌钙蛋白I，采用Image J软件计算曲线下面积；比较2组患者PCI术后1周和术后6个月超声心动图指标,比较2组患者入院时、术后24 h和术后1周血清结缔组织生长因子（CTGF）、微小RNA-92a（miR-92a）的表达。结果    PCI术后观察组患者呼吸频率、心率、胸腔积液和急性左心衰竭比例以及术后1、2、3 d中心静脉压水平均明显低于对照组，血氧饱和度明显高于对照组，差异均有统计学意义（均P＜0.05）。观察组患者PCI术后3 d内肌酸激酶同工酶和肌钙蛋白I曲线下面积均小于对照组［（3 251±1 004）U/L比（4 481±1 615）U/L，（3 668±939）μg/L比（4 539±1 096）μg/L］，差异均有统计学意义（均P＜0.001）。术后1周，2组患者左心室舒张末期容积、左心室收缩末期容积、左心室射血分数以及二尖瓣口舒张早期血流速度/二尖瓣口舒张晚期血流速度比值比较差异均无统计学意义（均P＞0.05），观察组二尖瓣口舒张早期血流速度/二尖瓣环舒张早期运动速度比值、室壁运动积分均低于对照组［(12±3)比（15±4），(1.73±0.18)分比（2.43±0.54）分］，差异均有统计学意义（均P＜0.001）。术后6个月，2组患者左心室舒张末期容积比较差异无统计学意义（P＞0.05）；但观察组左心室射血分数高于对照组［(52±12)%比（47±9）%］，室壁运动积分低于对照组［(1.68±0.36)分比（1.93±0.48）分］，差异均有统计学意义（均P＜0.05）。入院时，2组患者血清CTGF和miR-92a水平比较差异均无统计学意义（均P＞0.05）；术后24 h和术后1周，2组患者血清CTGF和miR-92a水平均明显低于本组入院时，且观察组低于对照组，差异均有统计学意义（均P＜0.05）。结论    老年STEMI患者PCI术后给予重组人脑利钠肽治疗，可明显缓解患者临床症状，抑制心脏重塑，并有效阻抑患者早期和远期心室重构，维护左心室功能，疗效显著。

• 【Abstract】Objective    To explore the effect of recombinant human brain natriuretic peptide on heart function in elderly ST-segment elevation myocardial infarction（STEMI） patients after percutaneous coronary intervention（PCI）. Methods    From March 2012 to March 2016, 83 elderly patients with STEMI undergoing emergency PCI in Xi′an No.1 Hospital were randomly divided into control group (n=42) and observation group (n=41). After PCI, the observation group was treated with conventional treatment plus recombinant human brain natriuretic peptide; the control group was treated with conventional treatment and 0.9% sodium chloride solution. Clinical symptoms and signs recovery were observed. Myocardial necrosis markers（creatine kinase isoenzyme and troponin I） were monitored in 3 d after admission; area under curve was analyzed by the Image J software. Echocardiographic indexes were analyzed 1 week and 6 months after PCI. Expressions of connective tissue growth factor（CTGF） and microRNA-92a（miR-92a）were detected on admission and 24 h, 1 week after PCI. Results    After PCI, respiratory rate, heart rate, proportions of pleural effusion and acute left heart failure, central venous pressures 1, 2, 3 d after operation in the observation group were significantly lower and blood oxygen saturation was significantly higher than those in the control group(P＜0.05). Areas under curve of creatine kinase isoenzyme and troponin I 3 d after PCI in the observation group were significantly lower than those in the control group［（3 251±1 004）U/L vs （4 481±1 615）U/L， （3 668±939）μg/L vs （4 539±1 096）μg/L］(P＜0.05). One week after PCI, left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular ejection fraction and mitral orifice early diastolic velocity to late diastolic velocity rate were similar between groups(P>0.05); mitral orifice early diastolic velocity to mitral annulus early diastolic velocity rate and wall motion score index in the observation group were significantly lower than those in the control group［(12±3) vs （15±4）, (1.73±0.18) vs （2.43±0.54）］(P＜0.05). Six months after PCI, left ventricular end-diastolic volume was similar between groups（P＞0.05）; left ventricular ejection fraction in the observation group was significantly higher and wall motion score index was significantly lower than those in the control group［(52±12)% vs （47±9）%, (1.68±0.36) vs （1.93±0.48）］(P<0.05). Expression levels of serum CTGF and miR-92a were similar between groups on admission(P>0.05). At 24 h and 1 week after PCI, serum CTGF and miR-92a significantly decreased; the levels in the observation group were lower than those in the control group(P<0.05). Conclusion    Human brain natriuretic peptide injection after PCI can relieve the clinical symptoms of STEMI, inhibit early and long-term cardiac remodeling and improve left ventricular function.