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目的比较N末端脑钠素原(NT-ProBNP)与QRS积分对急性心肌梗死(AMI)患者近期心功能判定价值。方法应用酶联免疫法测定49例患者AMI后5～7d血浆NT-ProBNP水平,同期应用12导联-心电图QRS积分评价梗死范围。随访AMI后第7d、1个月、3个月时超声心动图。结果AMI患者NT-ProBNP较正常对照组升高(P<0.01);前壁组和下壁+正后壁(+右室)组NT-ProBNP均高于下壁组(P<0.05),前壁组与下壁+正后壁(+右室)组之间差异无统计学意义。前壁组QRS积分高于下壁组和下壁+正后壁(+右室)组,差异有统计学意义(P<0.05);下壁组与下壁+正后壁(+右室)组之间差异无统计学意义(P>0.05)。下壁AMI心功能2级者血浆NT-ProBNP高于1级者,而两者QRS积分差异无统计学意义。AMI后5～7d的NT-ProBNP和QRS积分与心梗后第7d、1个月、3个月时左室射血分数(LVEF)、室壁运动积分(WMS)相关。结论血浆NT-ProBNP及QRS积分与AMI范围密切相关,是反映心室重构的较敏感指标;与QRS积分相比,血浆NT-ProBNP还可反映心功能状态,故更为优越。
Objective To compare the recent cardiac function determination of N-terminal pro-brain natriuretic peptide (NT-ProBNP) and QRS score in patients with acute myocardial infarction (AMI). Methods Serum NT-ProBNP levels were measured in 49 patients with AMI at 5-7 days by enzyme-linked immunosorbent assay (ELISA). The extent of infarction was assessed by 12-lead-ECG QRS integration. Echocardiography was performed at 7 days, 1 month and 3 months after AMI. NT-ProBNP in the anterior wall group and inferior wall + posterior wall (+ right ventricular) group were significantly higher than those in the inferior wall group (P <0.05) There was no significant difference between wall group and inferior wall + posterior wall (+ right ventricular) group. QRS score of anterior wall group was higher than inferior wall group and posterior wall + posterior wall (+ right ventricular) group, the difference was statistically significant (P <0.05); inferior wall group and posterior wall + posterior wall (+ There was no significant difference between groups (P> 0.05). Lower AMI cardiac function grade 2 plasma NT-ProBNP higher than 1, and the difference between the two QRS score was not statistically significant. The NT-ProBNP and QRS scores 5 to 7 days after AMI were correlated with left ventricular ejection fraction (LVEF) and wall motion score (WMS) at 7 days, 1 month and 3 months after myocardial infarction. Conclusions Plasma NT-ProBNP and QRS scores are closely related to the range of AMI and are more sensitive indicators of ventricular remodeling. Compared with QRS score, plasma NT-ProBNP can reflect the state of cardiac function, so it is more superior.