急性心肌梗死患者冠状动脉内支架植入术后血清内皮型一氧化氮合酶水平及心肌灌注的改变

Effects of Per Cutem Intracoronary Stenting on Serum Endothelial Nitric Oxide Synthase Level after Acute Myocardial Infarction

目的观察急性心肌梗死(AMI)患者冠状动脉内支架植入术(PCI)后血清内皮型一氧化氮合酶(eNOS)水平及心肌灌注的改变。方法将AMI患者分为PCI治疗组和非PCI治疗组,采用酶联免疫法测定AMI患者PCI治疗前,PCI治疗后3d及1、2、4、6、8周时血清eNOS的水平。非PCI治疗组在对应时间点抽血。比较两组患者不同病期血清eNOS水平的变化。两组患者均于AMI后4周行心肌99mTc甲氧基异丁基异腈(99mTc-MIBI)SPECT检查,比较心肌灌注程度。结果PCI治疗组、非PCI治疗组治疗前血清eNOS水平差异无统计学意义(P>0.05)。PCI治疗组术后3d及术后1、2、4、6、8周血清eNOS水平较非PCI治疗组明显升高,差异有统计学意义。术后4周时血清eNOS水平较术后2周、6周时血清eNOS水平明显升高。PCI组心肌灌注良好者24例(80%);而非PCI组心肌灌注良好者仅有5例(20%),两组比较差异有统计学意义(P<0.05)。结论AMI后早期PCI治疗可促进患者血清eNOS表达,改善心肌灌注,从而减轻缺血区心肌组织的损伤,改善心肌供血。

Objective To the effects of per cutem intracoronary stenting （PCI） on serum endothelial nitric oxide synthase （eNOS） level of cardiac muscle after acute myocardial infarction （AMI）.Methods Totally 55 AMI patients were randomly divided into PCI group （n=30） and non-PCI （n=25）.Serum eNOS was determined at seven different time points before treatment and 3 days and 1,2,4,6,and 8weeks after treatment using enzyme-linked immunosorbent assay.Myocardial perfusion changes were also compared between these two groups using ^99mTc-MIBI SPECT examination 4 weeks after AMI.Results The pre-treatment level of serum eNOS was not significantly different between PCI group and non-PCI group.Compared with non-PCI group,serum eNOS levels significantly increased in PCI group 3 days and 1,2,4,6,and 8 weeks after treatment （P0.05）.The eNOS level was significantly higher in Week 4 than in Week 2 and Week 6 postoperatively.Good myocardial perfusion was achieved in 24 patients （80%） in PCI group while only in 5 patients （20%） in non-PCI group （P0.05）.Conclusion Early PCI treatment after AMI can increase serum eNOS level and reduce myocardial damages by improving myocardial perfusion.