螺内酯对急性心肌梗塞后早期血清Ⅰ、Ⅲ型前胶原端肽水平的影响

Effects of aldosterone antagonist-spironolactone on the change of serum telopeptide of procollagen Ⅰ、Ⅲ after acute mvocardial infarction

目的:观察醛固酮拈抗剂——螺内酯(spironolactone)对急性心肌梗塞(AMI)患者早期血清Ⅰ型前胶原 (procollagcn I．PCI)端肽,Ⅲ型前胶原(PCⅢ)端肽含量的影响,探讨螺内酯能否抑制AMI后胶原合成以及阻抑 AMI后早期左室重塑。方法:44例AMI未经静脉溶栓或溶栓未成功的患者随机分为常规治疗组11例,螺内酯组17 例,卡托普利组16例,采用放射免疫法测44例患者发病后1周、4周血清Ⅰ型前胶原氨基末端肽(PINP)和Ⅲ型前 胶原氨基末端肽(PⅢNP)含量,超声心电图测左室舒张末期内径,室间隔厚度,左室后壁厚度,计算左室重量。结 果:①AMI后4周,螺内酯组血清PⅠNP,PⅢNP含量显著低于常规治疗组(P<0．05)．而Ⅰ／Ⅲ高于常规治疗且 与卡托普利组无明显差异;②螺内酯组治疗21天后其血清PⅠNP,PⅢNP及左室重量,左室舒张末期内径均较治疗 前下降,而Ⅰ／Ⅲ比值升高(P<0．05);③AMI后28天血清PⅢNP含量与左室重量,左室舒张末期内径呈正相关 (r=0．711、P<0．01,r=0．480、P<0．01)。结论:螺内酯可以抑制AMI后PC Ⅰ、PCⅢ合成,从而减轻左室重量, 抑制心室腔扩张,阻抑AMI后早期左室重塑,其效果与血管紧张素转换酶抑制剂卡托普利相近。

Objective： To observe the effects of spironolactone on the change of serum telopeptide of procollagen Ⅰ, Ⅱ patient with AMI after 4 weeks and to evacuate the restraints effects of spironolactone on early left ventricular remodeling（LVRM） following AMI. Methods：A total of 44 patients with AMI were entered into the study. The 11 patients were randomly divided into conventional treatment group （CTG）, 17 patients to spironolactone interventional group（SIG） and 16 patients to captopril interventional group （CIG）. At 1st week and 4th week after AMI serum aminoterminal propeptide of type Ⅰ （P Ⅰ NP） ,P Ⅱ NP were measured by radioimmunoassay and the left ventricular myocardium weight （LVMW）,left ventricular end-diastolic diameter （LVEDd） were measured by echocardiogram. Resuits：① The levels of serum P Ⅰ NP, P Ⅱ NP in SIG lower than those in CTG 28 d after AMI（P〈0.05）,there was no difference between SIG and CIG;② on 21 d after treatment of spironolactone, the levels of serum P Ⅰ NP,P Ⅱ NP and LVEDd.LVMW were lower obviously than those before therapy, while Ⅰ/Ⅱ was increased （P〈0.05） ;③ on 28 d After AMI the serum P Ⅱ NP correlated positively to LVMW,LVEDd significantly （r=0. 711 P〈0.01 ,r=0. 480.P 0.01）. Conelusion：Spironolactone may significantly inhibit the production of PC Ⅰ and PC Ⅱafter AMI, reduce LVMW,LVEDd and LVRM following AMI, where the effects on LVRM of spironolactone is similar to captopril.