Gill Denzil, Seidler Timothy, Troughton Richard W, Yandle Timothy G, Frampton Christopher M, Richards Mark, Lainchbury John G, Nicholls Gary
Christchurch Cardioendocrine Research Group, Department of Medicine, Christchurch School of Medicine and Health Sciences, P.O. Box 4356, Christchurch 8001, New Zealand.
Clin Sci (Lond). 2004 Feb;106(2):135-9. doi: 10.1042/CS20030131.
Acute myocardial infarction (MI) results in activation of neurohormonal systems and increased plasma concentrations of myocardial enzymes and structural proteins. We hypothesized that plasma levels of N-terminal pro-brain natriuretic peptide (NT-BNP) would respond more vigorously after MI than those of other natriuretic peptides. We also sought to compare this response with that of the established myocardial injury markers troponin T (TnT), myoglobin and creatine kinase MB (CK-MB). We obtained multiple blood samples for measurement of atrial natriuretic peptide (ANP), N-terminal pro-ANP, brain natriuretic peptide (BNP) and NT-BNP along with CK-MB, TnT and myoglobin in 24 patients presenting to the Coronary Care Unit within 6 h of onset of MI. Multiple samples were obtained in the first 24 h, then at 72 h, 1 week, 6 weeks and 12 weeks. NT-BNP increased rapidly to peak at 24 h and exhibited greater ( P <0.001) absolute increments from baseline compared with BNP and ANP, whereas NT-ANP did not change from baseline. Proportional increments in NT-BNP were also greater than those for the other natriuretic peptides ( P <0.05). Natriuretic peptide levels reached their peak around 24 h, later than peak TnT, CK-MB and myoglobin (peak between 1-10 h), and NT-BNP and ANP remained elevated on average for 12 weeks. Our present results, with detailed sampling of a cohort of acute MI patients, demonstrate greater absolute and proportional increments in NT-BNP than ANP or BNP with sustained elevation of these peptides at 12 weeks.
急性心肌梗死（MI）会导致神经激素系统激活，心肌酶和结构蛋白的血浆浓度升高。我们假设，心肌梗死后血浆N末端前脑钠肽（NT-BNP）水平的反应比其他利钠肽更为强烈。我们还试图将这种反应与已确立的心肌损伤标志物肌钙蛋白T（TnT）、肌红蛋白和肌酸激酶MB（CK-MB）的反应进行比较。我们在24例心肌梗死发病6小时内入住冠心病监护病房的患者中，采集了多个血样，用于检测心房利钠肽（ANP）、N末端前ANP、脑钠肽（BNP）和NT-BNP，以及CK-MB、TnT和肌红蛋白。在最初24小时内采集多个样本，然后在72小时、1周、6周和12周时采集。NT-BNP迅速升高，在24小时达到峰值，与BNP和ANP相比，其从基线的绝对增量更大（P<0.001），而NT-ANP与基线相比没有变化。NT-BNP的比例增量也大于其他利钠肽（P<0.05）。利钠肽水平在24小时左右达到峰值，晚于TnT、CK-MB和肌红蛋白的峰值（在1-10小时之间达到峰值），NT-BNP和ANP平均持续升高12周。我们目前对一组急性心肌梗死患者进行详细采样的结果表明，NT-BNP的绝对和比例增量比ANP或BNP更大，且这些肽在12周时持续升高。
