急性心肌梗死患者溶栓治疗后心肌再灌注损伤及血小板活化状态的研究

Study on myocardial reperfusion injury and platelet activation after thrombolytic therapy in patients with AMI

目的 :探讨急性心肌梗死 (AMI)患者尿激酶静脉溶栓治疗前后外周血中氧自由基 (OFR)、内皮素(ET)、血小板α颗粒膜蛋白 1 4 0 (GMP 1 4 0 )的动态变化及其与血管再通的关系。方法 :接受尿激酶静脉溶栓治疗的 38例 AMI患者在溶栓前及溶栓后 2、6、1 2和 2 4小时分别取血测定脂质过氧化物 (L PO)、超氧化物歧化酶 (SOD)、ET和 GMP 1 4 0 ,依间接指标及溶栓后 90分钟冠状动脉造影结果 ,将患者分为再通组 (2 7例 )和未通组 (1 1例 ) ,比较 2组患者血中上述指标的动态变化 ,并设正常对照组。结果 :AMI溶栓前 L PO、SOD、ET和 GMP 1 4 0浓度〔分别为 (1 .2 5 0± 0 .32 8) μmol/ L,(2 9.2 6± 1 2 .6 4) μU/ L,(37.5 5± 1 1 .2 5 ) ng/ L 和 (34 .37±9.2 5 ) μg/ L〕均高于正常对照组 ;溶栓治疗后再通组 L PO浓度较溶栓前明显升高 ,SOD则显著降低 ,未通组于溶栓前后无明显变化 ;溶栓后再通组 ET浓度较未通组高峰提前且峰值更高 ;溶栓后再通组 GMP 1 4 0浓度较溶栓前迅速下降 ,未通组则显著上升 ,2组相比差异显著。结论 :溶栓再通后 OFR的代谢紊乱及 ET的异常释放加重 (或 )介导心肌再灌注损伤 ,GMP 1 4 0与溶栓成功与否密切相关。 OFR、ET的动态监测及溶栓后 GMP1 4 0的迅速下降可望成为临床判断溶栓后血?

Objective:To observe the dynamic changes in oxygen free radical (OFR),endothelin (ET),platelet αgranule membrane protein (GMP140) before and after intravenous thrombolytic therapy with urokinase and their relationship with early reperfusion in patients with acute myocardial infarction (AMI).Methods:38 patients were included in the study.In 27 of them recanalization was successful and in 11 if failed according to indirect indexes and coronary arteriography.The concentrations of lipid peroxide (LPO),superoxide dismutase (SOD),ET and GMP140 were determined before thrombolytic therapy and 2,6,12 and 24 hours after completion of the urokinase infusion.35 healthy individuals were used as controls.Results:The concentrations of LPO,SOD,ET,GMP140 in AMI patients before thrombolytic therapy 〔(1 250± 0 328)μmol/L ,(29 26±12 64)μU/L,(37 55±11 25)ng/L and (34 37±9 25)μg/L,respectively〕 were significantly higher than those of controls.In reperfusion group,LPO increased quickly while SOD decreased significantly.There were no obvious changes before and after thrombosis in nonreperfusion group.ET release reached its peak at 2 hours after thrombolytic treatment in reperfusion group and at 6 hours after thrombolytic treatment in nonreperfusion group.Moreover,the ET peak was higher in reperfusion group as compared with that in nonreperfusion group.GMP140 decreased quickly after thrombolytic therapy in reperfusion group and increased obviously in nonreperfusion group.The difference between the two groups was significant.Conclusions:Disturbance of OFR metabolism and release of ET played important roles in myocardial reperfusion injury.GMP140 level reflected the effect of thrombosis of AMI.Dynamic mornitoring of LPO、SOD、ET、GMP140 in thrombolytic therapy may provide new supplementary indices for the assessment of early reperfusion.