急性前壁心肌梗死后心肌胶原纤维合成与心功能的研究

A study on myocardial collagen synthesis and heart function in patients with anterior acute myocardial infarction without early successful reperfusion

目的 探讨未成功实现早期再灌注的急性前壁心肌梗死患者心肌胶原纤维合成以及左室收缩、舒张功能指标的变化规律。方法 应用放射免疫法测定 4 5例急性前壁心肌梗死患者发病后第 5天、15天、30天、90天血清Ⅰ型前胶原羧基端肽 (PⅠCP)和Ⅲ型前胶原氨基端肽(PⅢNP)含量。超声测定患者出院前、第 90天的左室舒张末期内径 (LVEDd)、左室射血分数(LVEF)、二尖瓣舒张早期血流速度峰值 (E) /二尖瓣舒张晚期血流速度峰值 (A)的比值。将第 90天的E/A比值与血清PⅠCP和PⅢNP水平作相关分析。 30例健康人作为正常对照。结果 急性前壁心肌梗死患者发病后第 5天、15天、30天、90天血清PⅠCP和PⅢNP水平分别与对照组比较均明显升高 (P <0 .0 1)。急性前壁心肌梗死组在出院前和第 90天时的LVEDd均明显大于对照组 ,LVEF和E/A比值均明显低于对照组 (P <0 .0 1)。第 90天的E/A比值与血清PⅠCP和PⅢNP水平均呈明显负相关 (P <0 .0 0 1)。结论 未成功实现早期再灌注的急性前壁心肌梗死患者血清PⅠCP和PⅢNP含量明显增高并持续 3个月以上。左室舒张功能障碍与心肌纤维化密切相关。

Objective To investigate changes of myocardial collagen synthesis and heart function in patients with anterior acute myocardial infarction (AMI) without early successful reperfusion. Methods The serum concentrations of carboxyterminal propeptide of type Ⅰ procollagen (PⅠCP) and aminoterminal propeptide of type Ⅲ procollagen (PⅢNP) in 45 patients were measured by radioimmunoassay on the 5th, 15th, 30th and 90th days after anterior AMI. Before discharged and on the 90th day all patients underwent echocardiography to determine the left ventricular end-diastolic diameter (LVEDd), the left ventricular ejection fraction (LVEF) and the E/A ratio. Correlation analyses were made between the E/A ratio and the serum concentrations of PⅠCP and PⅢNP on the 90th day. 30 healthy people served as control group. Results Compared to the control group, the serum concentrations of PⅠCP and PⅢNP in anterior AMI group were significantly increased on the 5th, 15th, 30th and 90th days (P<0.01), and the LVEDd was significantly larger while the LVEF and E/A ratio were significantly lower before discharge and on the 90th day after infarction (P<0.01). There were significant negative correlations between the E/A ratio and the serum concentrations of PⅠCP and PⅢNP (P<0.001). Conclusions The serum concentrations of PⅠCP and PⅢNP increase significantly and elevate until 3 months after anterior AMI in patients without early successful reperfusion. There is a close relation between the dysfunction of left ventricle and myocardial collagen fibrosis.