急性心肌梗死静脉溶栓患者可溶性血管细胞黏附分子-1及循环内皮细胞的变化及镁剂治疗的意义

Changes of Soluble Intercellular Cell Adhesion Molecule-1 and Circulating Endothelial Cells Effect of Intravenous Magnesium Sulfate on Patients with Acute Myocardial Infarction with Thrombolytic Therepy

目的:观察镁剂治疗对急性心肌梗死(AMI)溶栓患者可溶性血管细胞黏附分子-1(sVCAM-1)、循环内皮细胞(CEC)的变化。方法:采用酶联免疫法(ELISA)及生化法测定89例AMI患者静脉溶栓前后sVCAM-1及CEC的含量。溶栓患者随机分为常规治疗组和镁剂治疗组,观察镁剂治疗对sVCAM-1及CEC含量的影响及对AMI患者再灌注心律失常(RAs)及缺血性心律失常(IA)发生率的影响。结果:AMI患者溶栓前后CEC及sVCAM-1较正常对照组均有明显升高,溶栓再通组溶栓后两者均有明显下降,两者呈明显正相关;镁剂治疗对两者变化无明显影响;但镁剂治疗组对RAs和IA的发生有明显预防作用。结论:sVCAM-1及CEC相互作用参与了AMI的循环炎症反应和再灌注损伤;镁剂治疗预防AMI患者的RAs和IA作用安全、可靠。

Objective：To observe the changes of soluble vascular cell adhesion molecule-1 （sVCAM-1） and circulating endothelial cells （CEC） and the effect of intravenous magnesium sulfate on patients with acute myocardial infarction （AMI） with thrombolytic therepy. Methods： Eighty nine patients with AMI admitted to our hospitals were treated with urokinase （UK）. Fourty five cases of them were randomly divided into urokinase （UK） plus magnesium sulfate （MS） （UM group） and fourty four cases into UK group. In UM group, MS was to used at 15 minutes before intravenous UK. sVCAM-1 and CEC were measured by enzyme linked immunosorbent assay （ELISA） and other biochemistry methods in these patients before and 6 hours after thrombolytic therepy. Meanwhile, the occurrences of thrombolysis-induced reperfusion arrhythmias （RAs） in AMI also were observed. Results： sVCAM-1 and CEC in patients with AMI increased remarkably as compared with control group （P〈0.01）, remarkably as compared with these patients without reperfusion （P〈0.01）, there was a obvious positive correlation between sVCAM-1 and CEC in patients with reperfusion decreased compared with those without reperfusion（r = 0. 489, P〈0.01 ）. Intravenous magnesium sulfate had no obvious influence on the levels of sVCAM-1 and CEC, However, the incidence and frequency of RAs in patients with preventive intravenous magnesium sulfate were significantly reduced compared with UK group in which lidocaine was used before intravenous UK （P〈0.01）. Conclusion： sVCAM-1 and CEC possibly play an important role in circulation demage in AMI,magnesium sulfate plays an important role in preventing RAs and severe arrhythmias.