血漿N末端腦鈉肽前體對(duì)急性心肌梗死溶栓治療的預(yù)后影響
發(fā)布時(shí)間：2018-08-07 18:45
【摘要】：目的 急性心肌梗死(acute myocardial infaction，AMI)是臨床最常見的心血管急癥。近年來研究顯示血漿N氨基酸末端腦鈉肽前體（N-Terminal proatrial B-type natriureticpetide，NT-proBNP）在心力衰竭（heart failure，HF）及AMI發(fā)作時(shí)明顯升高，并明顯影響患者的預(yù)后。如何來評(píng)價(jià)AMI患者的病情嚴(yán)重程度、預(yù)后已成為臨床醫(yī)學(xué)當(dāng)前面臨的重要問題之一。目前根據(jù)ACC/AHA及中華醫(yī)學(xué)會(huì)心血管分會(huì)制定的AMI診療指南，對(duì)ST段抬高的心肌梗死（ST segment elevation myocardial infaction，STEMI）的主要治療包括急診經(jīng)皮冠狀動(dòng)脈腔內(nèi)成形術(shù)（percutaneous coronaryintervention，，PCI）、靜脈溶栓，但對(duì)一些不具備急診PCI的醫(yī)院、有溶栓適應(yīng)癥的病人，給予靜脈溶栓治療，為行之有效的治療方法。目前國內(nèi)、外對(duì)NT-proBNP在心力衰竭及急性心肌梗死的應(yīng)用報(bào)道較多。對(duì)急診PCI術(shù)后患者中的診斷價(jià)值及臨床意義偶有報(bào)道。但對(duì)探討在經(jīng)過成功溶栓治療的患者中是否發(fā)生早期心血管事件，比較NT-proBNP在二組之間的差異，并研究其與血清肌鈣蛋白T（Troponin T，TnT）、肌酸激酶（creatine kinase，CK）、肌酸激酶同工酶（creatine kinase-CK）、左室射血分?jǐn)?shù)（left ventricular ejection，LVEF）、左室舒張末期容積（Left ventricular end diastolicdimension，LVEDD）之間的相關(guān)性，尚無報(bào)道。本研究旨在觀察成功溶栓患者中是否發(fā)生早期心血管事件，比較NT-proBNP在二組之間的差異，并研究其與血清肌鈣蛋白T、肌酸激酶、肌酸激酶同工酶、左室射血分?jǐn)?shù)，左室舒張末期容積之間的相關(guān)性，探討測(cè)定血漿NT-proBNP水平在評(píng)價(jià)AMI成功溶栓治療的患者病情嚴(yán)重程度和預(yù)后的意義。 材料與方法 研究對(duì)象為2009年10月至2012年6月于山東省東阿縣人民醫(yī)院住院治療的應(yīng)用瑞替普酶靜脈成功溶栓治療的AMI患者61例，其中男性45例，女性16例，年齡38-78歲，平均年齡62.41±9.408歲。其中廣泛前壁心肌梗死、前壁或前間壁心肌梗（前壁組）26例，下壁和或后壁、右室心肌梗死(下壁組)35例。對(duì)所有入選的患者記錄年齡、身高、體重、總膽固醇、低密度脂蛋白、肌酐、尿素氮、血糖、肌鈣蛋白T、心肌酶以及吸煙、高血壓、糖尿病史。記錄30天內(nèi)發(fā)生心血管死亡、心力衰竭、再發(fā)心肌梗死、梗死后心絞痛。所有入選病人治療前均進(jìn)行測(cè)定NT-proBNP、D二聚體、電解質(zhì)、血脂系列、血糖、肝、腎功能、感染免疫檢測(cè)及心電圖檢查。所有患者在入院時(shí)均行心臟超聲心動(dòng)圖檢查。對(duì)所有患者隨訪30天，觀察是否發(fā)生早期心血管事件，即30天內(nèi)發(fā)生心血管死亡、心力衰竭、再發(fā)心肌梗死、梗死后心絞痛等情況。采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)。計(jì)量資料以平均值±標(biāo)準(zhǔn)差(x s)表示。兩組之間比較采用t檢驗(yàn)。計(jì)數(shù)資料組間比較采用卡方檢驗(yàn)，p＜0.05為有統(tǒng)計(jì)學(xué)差異。血漿NT-proBNP數(shù)據(jù)呈非正態(tài)分布，經(jīng)對(duì)數(shù)轉(zhuǎn)換后呈正態(tài)分布。采用pearson相關(guān)分析法，對(duì)NT-proBNP分別與肌酸激酶、肌酸激酶同工酶、肌鈣蛋白T、LVEF及LVDD進(jìn)行雙變量相關(guān)分析。本研究的均數(shù)、標(biāo)準(zhǔn)差及t檢驗(yàn)均為NT-proBNP對(duì)數(shù)值分析結(jié)果。 結(jié)果 1.血漿NT-proBNP水平在發(fā)生早期心血管事件組明顯高于未發(fā)生事件組，兩組比較差異具有顯著性。 2.血漿NT-proBNP水平與左室射血分?jǐn)?shù)呈負(fù)相關(guān)。 3.血漿NT-proBNP水平與肌鈣蛋白T呈正相關(guān)，與肌酸激酶、肌酸激酶同工酶呈正相關(guān)；NT-proBNP與LVEDD呈正相關(guān)。 4.前壁血漿NT-proBNP水平明顯高于下壁組，但無統(tǒng)計(jì)學(xué)差異。 結(jié)論 1.血漿NT-proBNP水平在發(fā)生早期心血管事件組明顯高于未發(fā)生事件組。 2.血漿NT-proBNP水平與左室射血分?jǐn)?shù)呈負(fù)相關(guān)； 3.血漿NT-proBNP與LVEDD呈正相關(guān)；與肌鈣蛋白T與肌酸激酶、肌酸激酶同工酶呈正相關(guān)。
[Abstract]:objective
Acute myocardial infaction (AMI) is the most common clinical cardiovascular emergency. In recent years, studies have shown that plasma N amino acid terminal natriuretic peptide precursor (N-Terminal proatrial B-type natriureticpetide, NT-proBNP) is significantly elevated in heart failure (heart failure) and episodes of heart failure (heart failure), and significantly affects the prognosis of patients. How to evaluate the severity of AMI patients, the prognosis has become one of the most important problems in clinical medicine. At present, the main treatment for ST segment elevation myocardial infarction (ST segment elevation myocardial infaction, STEMI) is an emergency percutaneous coronary, according to the AMI guidance for the cardiovascular branch of the ACC/AHA and the Chinese Medical Association. Percutaneous CoronaryIntervention (PCI), intravenous thrombolysis, but for some hospitals without emergency PCI, patients with thrombolytic adaption and intravenous thrombolytic therapy are effective treatment methods. At present, there are more reports on the application of NT-proBNP in cardiac failure and acute myocardial infarction at home and abroad. Emergency PCI operation is used. The diagnostic value and clinical significance of the patients were reported occasionally. However, the difference between the two groups was compared between the two groups and the serum troponin T (Troponin T, TnT), the creatine kinase (creatine kinase, CK), and the creatine kinase isoenzyme (creatine kina). Se-CK), the correlation between left ventricular ejection fraction (left ventricular ejection, LVEF), left ventricular end diastolic volume (Left ventricular end diastolicdimension, LVEDD) has not yet been reported. The purpose of this study was to observe whether early cardiovascular events occurred in patients with successful thrombolytic disease and compare the difference between the two groups and study the difference between them and the serum. The relevance of troponin T, creatine kinase, creatine kinase isoenzyme, left ventricular ejection fraction, and left ventricular end diastolic volume, to explore the significance of plasma NT-proBNP levels in evaluating the severity and prognosis of patients with AMI successful thrombolytic therapy.
Materials and methods
The subjects were 61 AMI patients who were hospitalized in the people's Hospital of Dong'e County of Shandong province from October 2009 to June 2012 with successful thrombolytic thrombolytic therapy with riyrip vein, including 45 males, 16 females, 38-78 years old and an average age of 62.41 9.408 years. Among them, 26 cases were anterior wall myocardial infarction, anterior wall or anterior wall myocardial infarction (anterior wall group). 35 cases of lower wall and or posterior wall, right ventricular myocardial infarction (lower wall group). All selected patients were recorded age, height, weight, total cholesterol, low density lipoprotein, creatinine, urea nitrogen, blood glucose, troponin T, cardiac enzymes, and smoking, hypertension, and diabetes history. Records of cardiovascular death, heart failure, recurrent myocardial infarction, and post infarction within 30 days after the infarction. Angina pectoris. All patients were tested for NT-proBNP, D two polymer, electrolyte, blood lipid series, blood glucose, liver, kidney function, infection immunity test and electrocardiogram examination. All patients underwent cardiac echocardiography at admission. All patients were followed up for 30 days to observe whether early cardiovascular events occurred, that is, within 30 days. Blood vessel death, heart failure, recurrent myocardial infarction, and post infarction angina pectoris. SPSS19.0 software was used for statistics. The measurement data were expressed with mean standard deviation (x s). T test was used between the two groups. The count data were compared with the chi square test, P < 0.05 was statistically different. The plasma NT-proBNP data showed a non normal distribution, The Pearson correlation analysis was used to analyze the bivariate correlation of NT-proBNP with creatine kinase, creatine kinase isoenzyme, troponin T, LVEF and LVDD, respectively. The average number of this study, the standard deviation and the t test were all NT-proBNP to the numerical analysis.
Result
1. The plasma NT-proBNP level in the early cardiovascular event group was significantly higher than that in the non-event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. Plasma NT-proBNP levels were positively correlated with troponin T, creatine kinase and creatine kinase isozymes, and NT-proBNP levels were positively correlated with LVEDD.
4. the plasma NT-proBNP level in the anterior wall was significantly higher than that in the inferior wall group, but there was no statistical difference.
conclusion
1. the plasma NT-proBNP level in the early cardiovascular events group was significantly higher than that in the non event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. plasma NT-proBNP was positively correlated with LVEDD, and positively correlated with troponin T, creatine kinase and creatine kinase isoenzyme.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R542.22
本文編號(hào)：2171013
[Abstract]:objective
Acute myocardial infaction (AMI) is the most common clinical cardiovascular emergency. In recent years, studies have shown that plasma N amino acid terminal natriuretic peptide precursor (N-Terminal proatrial B-type natriureticpetide, NT-proBNP) is significantly elevated in heart failure (heart failure) and episodes of heart failure (heart failure), and significantly affects the prognosis of patients. How to evaluate the severity of AMI patients, the prognosis has become one of the most important problems in clinical medicine. At present, the main treatment for ST segment elevation myocardial infarction (ST segment elevation myocardial infaction, STEMI) is an emergency percutaneous coronary, according to the AMI guidance for the cardiovascular branch of the ACC/AHA and the Chinese Medical Association. Percutaneous CoronaryIntervention (PCI), intravenous thrombolysis, but for some hospitals without emergency PCI, patients with thrombolytic adaption and intravenous thrombolytic therapy are effective treatment methods. At present, there are more reports on the application of NT-proBNP in cardiac failure and acute myocardial infarction at home and abroad. Emergency PCI operation is used. The diagnostic value and clinical significance of the patients were reported occasionally. However, the difference between the two groups was compared between the two groups and the serum troponin T (Troponin T, TnT), the creatine kinase (creatine kinase, CK), and the creatine kinase isoenzyme (creatine kina). Se-CK), the correlation between left ventricular ejection fraction (left ventricular ejection, LVEF), left ventricular end diastolic volume (Left ventricular end diastolicdimension, LVEDD) has not yet been reported. The purpose of this study was to observe whether early cardiovascular events occurred in patients with successful thrombolytic disease and compare the difference between the two groups and study the difference between them and the serum. The relevance of troponin T, creatine kinase, creatine kinase isoenzyme, left ventricular ejection fraction, and left ventricular end diastolic volume, to explore the significance of plasma NT-proBNP levels in evaluating the severity and prognosis of patients with AMI successful thrombolytic therapy.
Materials and methods
The subjects were 61 AMI patients who were hospitalized in the people's Hospital of Dong'e County of Shandong province from October 2009 to June 2012 with successful thrombolytic thrombolytic therapy with riyrip vein, including 45 males, 16 females, 38-78 years old and an average age of 62.41 9.408 years. Among them, 26 cases were anterior wall myocardial infarction, anterior wall or anterior wall myocardial infarction (anterior wall group). 35 cases of lower wall and or posterior wall, right ventricular myocardial infarction (lower wall group). All selected patients were recorded age, height, weight, total cholesterol, low density lipoprotein, creatinine, urea nitrogen, blood glucose, troponin T, cardiac enzymes, and smoking, hypertension, and diabetes history. Records of cardiovascular death, heart failure, recurrent myocardial infarction, and post infarction within 30 days after the infarction. Angina pectoris. All patients were tested for NT-proBNP, D two polymer, electrolyte, blood lipid series, blood glucose, liver, kidney function, infection immunity test and electrocardiogram examination. All patients underwent cardiac echocardiography at admission. All patients were followed up for 30 days to observe whether early cardiovascular events occurred, that is, within 30 days. Blood vessel death, heart failure, recurrent myocardial infarction, and post infarction angina pectoris. SPSS19.0 software was used for statistics. The measurement data were expressed with mean standard deviation (x s). T test was used between the two groups. The count data were compared with the chi square test, P < 0.05 was statistically different. The plasma NT-proBNP data showed a non normal distribution, The Pearson correlation analysis was used to analyze the bivariate correlation of NT-proBNP with creatine kinase, creatine kinase isoenzyme, troponin T, LVEF and LVDD, respectively. The average number of this study, the standard deviation and the t test were all NT-proBNP to the numerical analysis.
Result
1. The plasma NT-proBNP level in the early cardiovascular event group was significantly higher than that in the non-event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. Plasma NT-proBNP levels were positively correlated with troponin T, creatine kinase and creatine kinase isozymes, and NT-proBNP levels were positively correlated with LVEDD.
4. the plasma NT-proBNP level in the anterior wall was significantly higher than that in the inferior wall group, but there was no statistical difference.
conclusion
1. the plasma NT-proBNP level in the early cardiovascular events group was significantly higher than that in the non event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. plasma NT-proBNP was positively correlated with LVEDD, and positively correlated with troponin T, creatine kinase and creatine kinase isoenzyme.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R542.22
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 顧國嶸;欒驍;姚晨玲;鄧至;童朝陽;;氨基端前腦鈉肽對(duì)急性心肌梗死患者院內(nèi)預(yù)后的判斷價(jià)值[J];中華臨床醫(yī)師雜志(電子版);2011年16期
2 趙睿;楊蕊;杜建霖;鄧松柏;王喜春;夏爽;佘強(qiáng);;B型利鈉肽聯(lián)合TIMI危險(xiǎn)積分對(duì)STEMI患者遠(yuǎn)期死亡風(fēng)險(xiǎn)預(yù)警價(jià)值的研究[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2010年04期
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