关键词: 前壁心肌梗死；糖尿病；利钠肽, 脑

Abstract: Objective  To investigate the effect of intravenous application of recombinant human brain natriuretic peptide(rhBNP) on renal function in patients with acute anterior myocardial infarction acute anterior myocardial infarction(AAMI) complicated with diabetes.
Methods  Fifty-three patients with AAMI combined with diabetes who underwent emergency percutaneous coronary intervention（PCI） were consecutively enrolled, and they were randomly divided into rhBNP group(n=25) and nitroglycerin group(NIT group, n=28). Two patients were given rhBNP and nitroglycerin for 72 h after direct percutaneous coronary intervention, respectively. Comparisons of levels of serum creatinine(SCr), cystatin C(CysC) and estimated glomerular filtration rate(eGFR) before and 24 hours, 72 hours and 7 days after medication were performed. Comparisons of urine volume, left ventricular ejection fraction(LVEF), early mitral valve diastolic blood flow peak(E) and early mitral annulus diastolic movement in both groups of patients before and 24 hours and 7 days after medication Speed(e′) ratio(E/e′) were also measured. The incidence of major adverse cardiac events(MACE) within 30 days was followed up.
Results  The levels of SCr and CysC in the rhBNP group increased firstly and then decreased, and the eGFR decreased firstly and then increased. The changes were most obvious at 72 h after treatment. All indexes returned to the baseline level 7 days after treatment. Levels of SCr and CysC, as well as levels of eGFR did not change significantly in the NIT group. There were statistically significant differences in the interaction between groups, time points, and groups·time points(P＜0.05). At 7 days after medication, the urine output during 24 hours in both groups was significantly less than 24 hours after medication(P＜0.05). At 7 days after treatment, the LVEF level in the rhBNP group was higher than 24 hours after treatment, and the E/e′ value was lower than 24 hours after the medication. The LVEF level in the rhBNP group was higher than that in the NIT group, and the E/e′ value was lower than that in the NIT group(P＜0.05 ). There was no significant difference in the incidence of MACE between the 2 groups(P＞0.05).
Conclusion  Intravenous administration of rhBNP may cause transient injury to renal function in patients with AAMI complicated with diabetes, but it could be restored in the short term with the improvement on the heart function.

Key words: anterior wall myocardial infarction, diabetes mellitus, natriuretic peptide, brain