药物与择期经皮冠状动脉介入治疗对急性心肌梗死后胶原重塑影响的对比研究

Contrastive Study on Medicine Treatment and Selective Percutaneous Coronary Artery Intervention on Influence of Cardiac Collagen Remodeling in Patients with Acute Myocardial Infarction

目的评价药物治疗与择期经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMl)后胶原重塑的影响。方法对41例AMⅠ患者分别予强化内科药物保守治疗(药物组,n=22例)和在此基础上予择期PCI治疗(PCI组,n=19例),应用酶联免疫法检测患者AMI发病1周、3个月、6个月及12个月时的血清I型前胶原羧基端肽(PICP)和Ⅲ型前胶原(PCⅢ)水平。以47例健康体检者为正常对照组。结果药物组和PCI组各时点亚组PICP及PCⅢ均较对照组显著升高(P<0.05)。两治疗组的6月亚组PICP较1周及3月亚组均显著升高(P<0.05),12月亚组PICP均较6月亚组显著降低(P<0.05);3月亚组PCⅢ均较1周亚组显著升高(P<0.05),12月亚组PCⅢ均较3月及6月亚组显著降低(P<0.05)。PCI组3月、6月亚组PICP以及3月亚组PCⅢ与药物组同时点相比均显著降低(P<0.05)。结论AMI后6个月内择期PCI在抑制胶原重塑方面明显优于药物治疗,而至12个月时两者相比无明显差异。

Objective To evaluate the influence of medicine treatment and selective percutaneous coronary intervention （PCI） on cardiac collagen remodeling in patients with acute myocardial infarction （AMI）. Methods 41 patients with AMI were divided into two groups which are the medicine treatment group （n=22） and selective PCI group （n=19） according to different therapies. Control group consisted with 47 people with health examination. The serum concentration of carboxy-terminal propeptide of procollagen type I （P I CP） and precollagen III（ PC III） of the patients with AMI were measured by enzymelinked immunosorbent assay （ELISA） on the first week, the third month, the sixth month and the twelfth month after AMI. Results Compared with the control group, the serum concentration of P I CP and PC III in bothof two groups increased significantly on the all times after AMI （P〈 0. 05）. In the medicine treatment group and selective PCI group, the level of P I CP were significantly higher on the sixth month than these on the first week and the third month, and were significantly lower on the twelfth month than these on the sixth month, while PC III were significantly higher on the third month than on the first week, and were significantly lower on the twelfth month than these on the third month and sixth month （P〈0. 05） . The serum concentrations of P I CP on the third month were significantly lower in the selective PCI group than these in the medicine treatment group （P〈0. 05）. Conclusion For inhibiting cardiac collagen remodeling, selective PCI is better than medicine treatment in the sixth month after AMI, while no significant differenced are observed on the twelfth month after AMI.