急性心肌梗死患者早期血管活性物质的变化及意义

Clinical significance of changes in plasma calcitonin generelated peptide,endothelin,and nitric oxide levels in patients with acute myocardial infarction

目的：观察急性心肌梗死（ Ａ Ｍ Ｉ）患者静脉溶栓前后早期血浆降钙素基因相关肽（ｃ Ｇ Ｒ Ｐ）、内皮素（ Ｅ Ｔ）和血清一氧化氮（ Ｎ Ｏ）水平的变化。方法：采用放射免疫法和比色分析法分别对静脉溶栓前后血管再通组（３０ 例），与未通组（２２ 例）的 Ａ Ｍ Ｉ患者及 ２０ 例正常人上述 ３ 种血管活性物质进行检测。结果： Ａ Ｍ Ｉ时患者ｃ Ｇ Ｒ Ｐ 再通组（３８６４±７１４）ｎｇ／ Ｌ，未通组（３２９８±１００７）ｎｇ／ Ｌ； Ｎ Ｏ 再通组（１８７１±３５６）μｍ ｏｌ／ Ｌ，未通组（１４８５±４０４）μｍ ｏｌ／ Ｌ； Ｅ Ｔ再通组（１３２６２±３１６３）ｎｇ／ Ｌ，未通组（１６７３３±３０６１）ｎｇ／ Ｌ；对照组分别为（５２９４±１４１７）ｎｇ／ Ｌ、（２１１７±６３４）μｍ ｏｌ／ Ｌ和（６６６５±１０６３）ｎｇ／ Ｌ，未通组较再通组变化更为明显。溶栓后１２ 小时，各组ｃ Ｇ Ｒ Ｐ、 Ｎ Ｏ 有所回升，但未通组ｃ Ｇ Ｒ Ｐ仍显著低于再通组（ Ｐ＜ ００５）；再通组 Ｅ Ｔ 继续升高，未通组则开始下降。溶栓后２４ 小时，２ 组ｃ Ｇ Ｒ Ｐ和 Ｎ Ｏ 继续升高，再通组 Ｅ Ｔ 下降，未通组则略有升高。结论：血浆ｃ Ｇ Ｒ Ｐ?

Objective:To observe the changes in plasma calcitonin generelated peptide (cGRP),endothelin(ET),and serum nitric oxide (NO) levels before and after thrombolytic therapy in patients with acute myocardial infarction (AMI).Methods:The patients with AMI were divided into two groups:reperfusion group (group A, n =30) and nonreperfusion group (group B, n =22).Immunoradiometric assay was used to measure the plasma cGRP and ET in patients and 20 normal subjects,and colorimetric analysis method was used to measure the serum NO levels.Results:In patients with AMI,plasma cGRP 〔group A and B:(38 64± 7 14)ng/L and (32 98±10 07)ng/L〕and serum NO 〔group A and B:(18 71±3 56)μmol/L and (14 85±4 04)μmol/L〕 levels decreased,while plasma ET 〔group A and B:(132 62±31 63)ng/L and (167 33±30 61)ng/L〕 levels increased compared with normal controls,respectively 〔(52 94±14 17)ng/L,(21 17±6 34)μmol/L,and (66 65±10 63)ng/L〕,and changes in these parameters were more pronounced in group B.At 12 hours after thrombolytic therapy,the levels of cGRP and NO in group A and B were slightly elevated whereas cGRP levels were much lower in group B compared with group A ( P <0 05).In group A,ET levels gradually increased,but it decreased in group B.At 24 hours after thrombolytic therapy,cGRP and NO levels further elevated in both groups.while ET levels decreased in group A with slight increase in group B.The levels of ET in groups A and B were still significantly higher than those of controls ( P <0 01).Conclusions:The plasma cGRP,ET and serum NO may be involved in the pathogenesis of AMI during early stage.The increase of ET and decrease of cGRP and NO within 24 hours of AMI might unfavorably affect for thrombolysis therapy.