急性ST段抬高型心肌梗死患者急诊介入术中血栓抽吸对缺血修饰性白蛋白的影响

The impact of thrombus - aspiration on ischemia modified albumin during emergency percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

目的评价在急性ST段抬高型心肌梗死（STEMI）患者急诊介入术中血栓抽吸对缺血修饰性白蛋白（IMA）的影响。方法选择2009年5月至2010年8月收治的STEMI患者共92例，其中急诊介入术加血栓抽吸治疗者为血栓抽吸组（n=45），同时期条件相当仅行急诊介入治疗患者作为标准PCI组（n=47），比较两组的基础资料及IMA、脑尿钠肽（BNP）和肌酸激酶同工酶（CK—MB）情况。结果两组术后30minIMA比术前明显升高（P〈0．05），且血栓抽吸组低于普通PCI组，3h逐渐降到术前水平。BNP在术后明显升高（P〈0．05），而肌酸激酶同工酶在术后12h到达峰值，血栓抽吸组均低于术后同时间普通PCI组。结论IMA可作为心肌缺血早期诊断的重要指标之一，血栓抽吸能改善介入治疗后心肌微灌注并减少心肌酶的释放，从而减少心肌梗死面积。

Objective To evaluate the impact of thrombus - aspiration on isehemia modified albumin（IMA） during emergency percutaneous coronary intervention （PC I）in patients with acute ST segment elevation myocardial infarction（STEMI）. Methods The STEMI patients underwent emergent PCI from May 2009 to August 2010, 45 patients received aspiration thrombectomy were enrolled in study group, and those 47 patients who only received routine PCI were enrolled in control group. The clinical data, information after operation and the IMA, brain natriuretic peptides （BNP） and creafine kinase isoenzyme - MB（ CK - MB） were compared between the two groups. Results IMA levels were elevated 30 minutes after PCI （ P 〈 0.05 ） , compared with control group, thrombus aspiration group had lower serum IMA level; They were decreased to the levels before PCI in 3 hours. The BNP levels were raised after PCI,The CK - MB level were raised the peak value in 12 h after PCI; The study group had lower serum CK - MB and BNP level. Conclusions IMA is a sensitive marker of myocardial ischemia, thrombus - aspiration could improve myocardium perfusion and reduce myocardial necrosis.