急性心肌梗死患者溶栓治疗过程中血浆前列环素和血栓素A_2的变化及其意义

Clinical significance of changes in plasma prostaglandins and thromboxane A 2 during thrombolysis in patients with acute myocardial infarction

目的：探讨急性心肌梗死（ＡＭＩ）患者溶栓治疗过程中血浆前列环素（ＰＧＩ２）及血栓素Ａ２（ＴＸＡ２）变化与再灌注损伤的关系。方法：将发病２４小时内入院的１０４例ＡＭＩ患者随机分为溶栓组６０例与未溶栓组４４例；溶栓组连续３日测定外周血ＰＧＩ２和ＴＸＡ２的代谢产物６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α）和血栓素Ｂ２（ＴＸＢ２）的浓度；并计算６ｋｅｔｏＰＧＦ１α／ＴＸＢ２比值（Ｋ／Ｔ）。结果：溶栓血管再通组（４２例）的６ｋｅｔｏＰＧＦ１α和ＴＸＢ２水平均高于溶栓血管未通组（１８例）和未溶栓组，以ＴＸＢ２增加的幅度更大，表现为溶栓血管再通组Ｋ／Ｔ比值显著低于后２组（Ｐ＜０．０１）；而溶栓血管未通组与未溶栓组间上述指标无显著性差异（Ｐ均＞０．０５）。另外，溶栓血管再通组中有再灌注心律失常者的Ｋ／Ｔ比值（０．７７±０．０７）显著低于无再灌注心律失常者（０．８８±０．１４，Ｐ＜０．０５）。结论：ＡＭＩ时ＰＧＩ２与ＴＸＡ２平衡失调，其与再灌注心律失常的发生和冠状动脉再通的病理生理过程有关。溶栓治疗时。

Objective:To study clinical significance of changes in prostaglandin I 2(PGI 2) and thromboxane A 2 (TXA 2) during thrombolysis in patients with acute myocardial infarction (AMI).Methods:104 patients with confirmed AMI hospitalized within 24 hours from the onset of symptoms were randomized into two groups:thrombolysis ( n =60),and nonthrombolysis ( n =44).6ketoPGF 1α and TXB 2,metabolites of PGI 2 and TXA 2 respectively,in peripheral venous blood samples were measured and 6ketoPGF 1α /TXB 2 (K/T) ratio was calculated for 3 days.Results:Plasma concentrations of 6ketoPGF 1α and TXB 2 in reperfusion group( n =42) were higher than those in nonreperfusion( n =18) and nonthrombolysis groups.Particularly,TXB 2 elevated much higher and it resulted in K/T ratio decrease in reperfusion group compared with those in other groups ( P <0 01),while there was no significant difference between nonreperfusion and nonthrombolysis groups (all P >0 05).Additionally,K/T ratio was found to be lower in patients with reperfused arrhythmia than those without reperfused arrhythmia in reperfusion group (0 77±0 07 vs.0 88±0 14, P <0 05).Conclusions:This result is likely to reflect that the imbalance of PGI 2 and TXA 2 may be involved in reperfusion arrhythmia and reperfusion process.