心肌梗死后神经内分泌激活与心脏胶原重塑的研究

Study on the Activation of Neuroendocrine and Collagen Remodeling after Myocardial Infarction

目的探讨急性心肌梗死(AMI)后患者神经内分泌激活与AMI后心脏胶原重塑的关系。方法65例首次发病的AMI住院患者(AMI组),于发病后1周、3个月、6个月时采用酶联免疫吸附实验测定血清肾素(Renin)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、去甲肾上腺素(NE)、Ⅰ型前胶原羧基端肽(PⅠCP)和Ⅲ型前胶原(PCⅢ)含量,并计算PⅠCP/PCⅢ比值。以48例健康体检者作为正常对照组。结果与对照组比较,AMI3个月亚组、6个月亚组的PⅠCP和各时间点的PCⅢ水平均明显高于对照组(P<0.05),且呈逐渐升高趋势,AMI组的PⅠCP/PCⅢ比值明显低于对照组;AMI后各时点的Renin、AngⅡ及1周亚组的ALD均低于对照组(P<0.05),而AMI后1周亚组、3个月亚组的NE均高于对照组(P<0.05)。结论AMI后心脏胶原过度沉积,交感神经系统和肾素-血管紧张素-醛固酮系统参与AMI后心脏胶原重塑。

Objective To observe the relationship between activation of neuroendocrine and collagen remodeling after acute myocardial infarction （AMI）. Methods Sixty-five patients with AMI and 48 normal controls （age-, sex-matched） were enrolled. Blood samples were obtained from the normal controls and the patients with AMI on 1st week, the 3rd month and the 6th month after AMI, the serum levels of Renin, angiotensin Ⅱ（Ang Ⅱ）, aldosterone （ALD）, norepinephrine （NE）, the carboxy-terminal propeptide of type Ⅰ procollagen （P Ⅰ CP） and precollagen Ⅲ （PCⅢ） were measured by enzyme-linked immunosorbent assay （ELISA）. Results Compared with the normal control, serurn concentration of P Ⅰ CP on the 3rd month and the 6th month after AMI, and PCⅢ at all times increased, while the ratio of P Ⅰ CP/PCⅢ decreased. The serum level of Renin and Ang Ⅱ at all times, as well as ALD on the 1st week after AMI were significantly lower, while NE on the 1st week and the 3rd month in patients with AMI were significantly lower, while NE on the 1st week and the 3rd month in patients with AMI were higher than those in normal controls. Conclusion The deposit of cardiac collagen significantly increases after AML The activated rennin-angiotensin-aldosterone system and sympathetic nervous system may take part in cardiac collagen remodeling.