缺血后适应对急性心肌梗死患者临床及预后的影响

Effect of ischemic postconditioning on prognosis in acute myocardial infarction patients

目的探讨急性心肌梗死(AMI)患者施行缺血后适应能否有效地降低缺血再灌注损伤,从而对心脏产生保护作用。方法选取AMI患者42例,随机分为对照组22例和缺血后适应组20例。监测2组患者PCI术前、术后2h、1、2、3d内肌酸激酶同工酶(CK-MB)值,并测定CK-MB峰值及各时间点下CK-MB平均值曲线下面积;监测PCI术前及术后2h血清C反应蛋白(CRP)、丙二醛和超氧化物歧化酶(SOD)水平;比较2组患者PCI术前及术后24h内心电图ST段回落情况。结果缺血后适应组CK-MB峰值明显低于对照组[(570.61±41.27)U/L vs(661.80±58.55)U/L,P<0.01];CK-MB平均值曲线下面积明显低于对照组[(5821.19±2912.07)%vs(9843.12±3578.02)%,P<0.01];缺血后适应组术后2hCRP下降幅度明显低于对照组(P<0.05);缺血后适应组术后丙二醛下降较对照组明显(P<0.05);缺血后适应组术后SOD升高较对照组明显(P<0.01);缺血后适应组ST段回落情况较对照组高(60.0%vs 45.5%,P<0.05),对照组中有2例患者因发生恶性心律失常死亡。结论AMI患者施行缺血后适应处理能够降低CK-MB的释放,降低氧自由基含量,减轻炎性反应,使冠状动脉恢复血流情况占有明显优势,能够明显降低再灌注损伤,发挥心脏保护作用。

Objective To study whether ischemic postconditioning can effectively reduce ischemia/reperfusion （I/R）injury in acute myocardial infarction （AMI）patients .Methods Forty-two AMI patients admitted to our hospital were randomly divided into control group （n=22） and ischemic postconditioning group （n=20） .CK-MB value and average area under CK-MB curve were measured before and 2 h ,1 ,2 ,3 days after PCI .Serum levels of CRP ,MDA and SOD were measured before and 2 h after PCI .ST segment falls on ECG were compared before and 24 h after PCI .Malignant arrhythmia in the patients was recorded during their hospital stay .Results The peak CK-MB value ,average area under CK-MB curve ,serum levels of CRP and MDA were significantly lower while the serum SOD level was significantly higher in ischemic postconditioning group than in control group after PCI （P〈0 .05 ,P〈0 .01） .The ST segment fall was faster in ischemic post-conditioning group than in control group .Two patients in control group died of malignant arrhythmia .Conclusion Ischemic postconditioning can reduce the CK-MB release ,oxygen free radical level ,inflammatory reaction ,I/R injury and restore coronary blood flow in AMI patients ,thus playing a role in protecting the heart .