急性心肌梗死患者溶栓治疗前后血浆VEGF-A水平的变化

Alteration of VEGF-A before and after thrombolytic therapy in acute myocardial infarction

目的探讨急性心肌梗死患者溶栓治疗前后血管内皮生长因子-A(vascular endothelia growth factor-A,VEGF-A)水平的变化及其临床意义。方法选取溶栓治疗急性心肌梗死患者28例及冠状动脉造影正常对照组25例。采用酶联免疫吸附法测定血浆VEGF-A的水平。结果急性心肌梗死组血浆VEGF-A水平显著高于对照组,溶栓治疗后2h血浆VEGF-A水平显著下降,差异均有统计学意义(P<0.01)。治疗后12h血浆VEGF-A水平仍高于正常对照组,差异有统计学意义(P<0.05)。血管未通组治疗前血浆VEGF-A的水平显著高于血管再通组,差异有统计学意义(P<0.05),治疗后各时间点未通组略高于再通组水平,但差异尚未达到统计学意义(均P>0.05)。结论增高的血浆VEGF-A的水平参与了急性心肌梗死病理过程,VEGF-A的水平是反映心肌缺血的敏感指标,但是尚不能作为有效评价溶栓治疗效果的指标。

Aim To observe the alteration of VEGF-A in acute myocardial infarction（AMI）before and after thrombolytic therapy,and explore its relation with AMI and clinical significance.Methods Patients（n=28） with AMI received thrombolytic therapy were selected,and control patients（n=25）who had normal coronary angiograms were included in the study.Plasma VEGF-A level was measured by enzyme linked immunosorbent assay（ELISA）.Results Before thrombolytic therapy,the plasma levels of VEGF-A in patients with AMI were significantly higher than that in the control group（P〈0.01）.Two hours after thrombolysis,the plasma levels of VEGF-A was significantly lower and was further decreased in twelve hours after thrombolysis,but they still higher than the control group（P〈0.05）.Before thrombolysis,the plasma concentrations of VEGF-A in the group of non-reperfusion was significantly higher than the group of reperfusion（P〈0.05）.The plasma concentrations of VEGF-A in the group of non-reperfusion was slightly higher than the group of reperfusion after thrombolysis,but there was no significant difference between them（P〉0.05）.Conclusions The plasma concentrations of VEGF-A elevation following AMI strongly suggests that VEGF-A may be involved in the pathophysiological procedure of AMI.The plasma levels of VEGF-A may be a sensitive indicator for myocardial ischemia,but still can not serve as a useful indicator in accessing and judging the effect of thrombolytic therapy.