粒细胞发光在急性心肌梗死溶栓治疗中的应用

The Study of Polymorphonuclear Leukocyte Chemiluminescence in Thrombolytic Therapy for Acute Myocardial Infarction

目的:研究急性心肌梗死(AMI)患者静脉溶栓前后的中性粒细胞(PMN)氧化代谢活性的变化,并探讨其作为冠脉再通指标的可行性。方法:选择发病在6小时以内的AMI患者80例,给予静脉溶栓,按溶栓后冠脉是否再通分为溶栓再通组(Ⅰ组)54例及溶栓未通组(Ⅱ组)26例。以同样发病时间的52例未溶栓病人作为对照组(Ⅲ组)。采用鲁米诺依赖的全血化学发光法(CL)测量3组病人的PMN-CL峰值和吞噬指数。同时测量同期PMN数目、CK-MB及SOD。结果:(1)Ⅱ组和Ⅲ组的PMN-CL峰值及吞噬指数均在发病后24小时达高峰,而Ⅰ组的相应值前移至发病后16小时。(2)3组PMN-CL吞噬指数均与各自CK-MB变化呈正相关。(3)Ⅰ组SOD峰值出现于16小时,Ⅱ、Ⅲ组出现于24小时,均与各自的PMN-CL峰值呈显著正相关。结论:缺血再灌注时,PMN氧化代谢活性增强,PMN-CL峰值及吞噬指数高峰前移可作为AMI溶栓再灌注成功的临床指标。

Objective;To study the change of the polymorphonuclear leukocyte (PMN) oxidizing metabolism activity in patients with acute myocardial infarction (AMI) undergoing intravenous thrombolytic therapy and explore whether it will be feasible to serve as a clinical index of coronary reperfusion. Methods:Eighty cases of AMI who were attacked within 6 hours underg-oing intravenous thrombolytic therapy were divided into reperfusion group (group Ⅰ,54 cases) and non-reperfusion group (group Ⅱ,26 cases),group Ⅲ included 52 cases not undergoing thrombolytic therapy. Using luminol dependent whole blood chemiluminescence (CL) ,peak value and phagocytic index were measured,PMN numbers,CK-MB and SOD were also mea-sured. Results: (1 )Peak value and phagocytic index in both group Ⅱand group Ⅲ peaked at 24 hours of attack and those of group Ⅰ moved up to 16 hours. (2)There was stronger positive correlation between phagocytic index and CK-MB in the three groups respectively. (3)SOD in group Ⅰ peaked at 16 hours and that of group Ⅱ and groupⅢ peaked at 24 hours, there was stronger positive correlation with their own peak values. Conclusion:The function of PMN in patients with AMI increased in myocardial ischemia and reperfusion. The moving-up of peak value and phagocytic index could be regarded as another clinical reperfusion index in patients undergoing thrombolytic treatment.