补救性冠脉支架置入患者血C-反应蛋白水平变化

Effects of rescue percutaneous coronary stent on C-reactive protein levels in patients with acute myocardial infarction

目的观察补救性冠脉支架置入对急性心肌梗死(AMI)患者C-反应蛋白(CRP)水平的影响。方法52例AMI静脉溶栓失败患者分为两组。A组32例,静脉溶栓失败2周后行冠状动脉造影并对病变血管置入冠脉支架;B组20例,溶栓失败90min内急诊对"罪犯血管"补救性置入冠脉支架。全部患者分别于溶栓前、后或补救性冠脉支架置入术后1、2、3、7d采集静脉血测定CRP水平。结果A组溶栓前CRP为(9.26±5.21)mg/L,支架置入后1、2、3d血清CRP水平和溶栓前比较无显著性差异(P>0.05),支架置入后7dCRP水平较溶栓前明显降低(≤3mg/L,P<0.01)。B组溶栓前CRP为(8.79±4.85)mg/L,溶栓及补救性冠脉支架术后1、2、3dCRP水平高于溶栓前(P<0.01);支架置入后第7d两组CRP水平比较无显著性差异(P>0.05)。结论AMI静脉溶栓失败行补救性冠脉支架置入术后血CRP水平升高明显,可能与局部炎症反应或局部血管内膜撕裂有关。

Objective To observe the effects of delayed and rescue percutaneous coronary stent on C- reactive protein levels in patients with acute myocardial infarction （AMI）. Methods The 52 patients with AMI and defeat of thrombolysis were studied successively. The first 32 cases （group A） were diagnosed as failed of thrombolysis according to the dynamic change of ECG and myocardium enzyme. The another 20 cases （group B） were diagnosed as failed of thrombolysis according to the dynamic change of ECG and myocardium enzyme and according to coronary angiography at 90min after thrombolytic therapy. Then coronary stent was implanted in the ＂crime vessel＂. Serum C-reactive protein （CRP） concentrations of venous blood samples were determined before thrombolytic therapy and on the 1st, 2nd and 3rd and 7th after thrombolytic therapy or rescue percutaneous coronary stent implantation respectively. Results There were no significant differences on the 1st, 2nd and 3rd after thrombolytic therapy in group A （P〉0.05）, compared with preceding serum CRP concentrations. Serum CRP concentrations were closed to normal level on the 7th after thrombolytic therapy and reduced obviously compared with that of preceding thrombolytic therapy （P〈0.01）. Serum CRP concentrations were higher than that of preceding thrombolytic therapy on the 1st, 2nd and 3rd after the procedure of rescue pereutaneous coronary stent implantation ill group B （P〈0.01）. There were no significant differences between two groups in the serum CRP concentrations on the 7th after thrombolytic therapy （P 〉0.05）. Conclusion Serum CRP concentrations increase obviously after rescue percutaneous coronary stent implantation. It may be related to local inflammation reaction or local injury of intima.