急性心肌梗死不同时期血浆一氧化氮及内皮素变化的临床研究

Changes of plasma endothelin and nitric oxide during acute myocardial infarction in humans

目的:探讨内皮细胞损伤在急性心肌梗死发病中的作用及与梗塞相关并发症的关系。 方法:将 71例急性心肌梗死病人分为 2组 :A组 4 1例 ,为无梗塞后缺血事件发作及严重并发症 ;B组 30例 ,为有梗塞后缺血事件发作及严重并发症 ,并设立对照组 15例。梗塞后 4～ 6、2 4、72 h及 1周采用放免法测定血浆内皮素 (ET) ,铜离子活化镉还原法测定血清中硝酸盐 (NO3- ) ,采用 Swan- Ganz导管测定肺毛细血管楔嵌压 (PCWP)。 结果 :A组血浆ET在发病 4～ 6 h迅速升高 ,2 4 h达高峰 ,1周恢复正常。而血浆 NO于发病 2 4 h开始升高 ,72 h达高峰值 ,1周恢复正常。B组 ET在各个时点上均高于 A组 ,在 1周后仍高于对照组 ,B组血浆 NO在各个时点上均低于 A组 ,1周后仍低于对照组。且 ET与 PCWP呈显著正相关关系 (r =0 .82 ) ,而 NO与 PCWP无显著相关性。 结论:急性心肌梗死时动态观察血浆 ET、NO的变化 ,有助于判定梗塞后缺血事件的发生及并发症的出现 ,且血浆

Objective: To investigate the effect of endothelial injury in acute myocardial infarction(AMl) and the relation between nitric oxide(NO), endothelin(ET) and complications of myocardial infarction. Methods: 71 patients with AMl were divided into two groups: group A, 41 patients with uncomplicated AMI, group B, 30 patients with the onset of ischemia and serious complication after AMI, normal control group, 15 subjects. Plasma ET and NO were measured by radioimmunoassary and by activated cadmium reduction method in 4~6 hours, 72 hours and 1 week after AMI, Swan Ganz catheter was used to measure the pulmonary capillary wedge pressure(PCWP). Results: The plasma ET levels in group A rose sharply at 4th hours and 6th hours after onset of chest pain, reached a peak level at the 24th hours and returned to normal in 1 week. The plasma ET level in group B was higher than group A in each time point and remained higher than normal group at 1 week; the plasma NO level in group B was lower than group A in each time point, and remained lower than normal group at 1 week. There were significant positive correlation between ET and PCWP (r=0.82) and no correlation between NO and PCWP. Conclusion: Observation of the changes of plasma level ET and NO in different phase of AMI could help us to decide the occurrence of ischemic events and complications, and the sustained increase of plasma ET level could result in depression of cardiac function.