Effects of early spironolactone treatment in patients with acute myocardial infarction expecting to proceed primary percutaneous coronary intervention
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摘要: 目的:探讨早期应用螺内酯治疗对行急诊介入治疗的急性心肌梗死(AMI)患者的短期影响。方法:入选行急诊介入治疗的AMI患者201例,在常规治疗的基础上随机分为螺内酯组100例及对照组101例。所有患者在治疗前及治疗后1、3个月检测血浆醛固酮和Ⅲ型前胶原肽(PⅢNP)、B型脑钠肽(BNP)及N端B型脑钠肽前体(NT-proBNP),统计BNP>200pg/ml和(或)NT-proBNP>450(年龄<50岁)、>900(年龄50~75岁)、>1 800pg/ml(年龄>75岁)的发生率。监测血钾、肾功能。结果:治疗1、3个月时两组血浆醛固酮均被抑制,螺内酯组被抑制得更明显(均P<0.05);两组PⅢNP水平均较治疗前显著增长,对照组较螺内酯组增长更明显(均P<0.05);BNP>200pg/ml和(或)NT-proBNP>450(年龄<50岁)、>900(年龄50~75岁)、>1 800pg/ml(年龄>75岁)的发生率,螺内酯组较对照组明显减少(均P<0.05)。两组均无严重高钾血症发生,螺内酯组低钾血症发生率较对照组明显减低(P<0.05)。结论:对行急诊介入治疗的AMI患者早期应用螺内酯可进一步降低血浆醛固酮、PⅢNP水平,减少BNP和(或)Pro-BNP升高的发生率,且在严格监测下应用安全。Abstract: Objective:To investigate the effects of early spironolactone treatment in patients with acute myocardial infarction expecting to proceed primary percutaneous coronary intervention.Method:There were 201 acute myocardial infarction patients expecting to proceed primary percutaneous coronary intervention were enrolled and randomly assigned to spironolactone group(n=100)and control gaoup(n=101).The plasma aldosterone and Nterminal procollagen Ⅲ propeptide(PⅢNP),brain natriuretic peptide(BNP)and N-Terminal B-type natriuretic peptide(NT-proBNP)were examined,as well as the incidences of BNP>200pg/ml and/or NT-proBNP>450(age<50years),>900(age 50-75years),>1 800pg/ml(age>75years)were calculated before and after 1,3months of therapy.The serum potassium and renal function were monitored.Result:After 1and 3months of treatment,plasma aldosterone was suppressed in the two groups,and spironolactone group was suppressed more significantly(P<0.05);PⅢNP increased signicantly in the two groups and control group increased more significantly(P<0.05);the incidence of BNP>200pg/ml and/or NT-proBNP>450(age<50years),>900(age 50-75years),>1800pg/ml(age>75years)in spironolactone group was lower than that in control group(P<0.05).There was no severe hyperkalemia occurred in the two groups,the incidence of hypokalemia in spironolactone group was significantly lower than that in control group.Conclusion:Early treatment of spironolactone can depresse plasma aldosterone and PⅢNP,Inhibiti the elevation of BNP and(or)Pro-BNP in patients with acute myocardial infarction expecting to proceed primary percutaneous coronary intervention.It is safe in rigorous monitor.
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