ST段抬高型急性心肌梗死合并缺血性J波血浆溶血磷脂酸含量变化的研究

Changes of plasma lysophosphatidic acid levels in patients with the hyperacute ST-elevated myocardial infarction combined with ischemic J wave

目的观察ST段抬高型急性心肌梗死（STEMI）合并缺血性J波的电生理特征及患者血浆溶血磷脂酸含量的变化，为临床早期预警和早期干预提供依据。方法选取经临床和辅助检查确诊的128例STEMI患者，根据有无J波分为缺血性J波组及非J波组。另选110例健康体检人群为对照组。比较各组间临床、电生理特征、血浆溶血磷脂酸（LPA）含量及相关性。结果128例STEMI患者中缺血性J波的发生率为29．7％；与非J波组相比，J波组STEMI超急期伴下壁及多部位梗死发生率高（P〈0．05），STEMI超急期发生于右冠状动脉梗死的比率高（P〈0．05），STEMI超急期合并恶性心律失常的发生率明显升高（P〈0．05）。STEMI组血浆LPA含量较对照组显著升高（P〈0．01），J波组血浆LPA含量较非J波组显著升高（P〈0．01）。结论STEMI超急期缺血性J波多见于右冠脉受累、下壁梗死的患者，易导致恶性室性心律失常。STEMI超急期血浆LPA显著升高，伴缺血性J波患者LPA升高更明显。缺血性J波联合LPA可作为理想的电生理和生化标记物用于临床的早期预誓和早期干预。

Objective To observe the electrocardiographic characteristics of patients with ST-elevated hyperacute myocardial infarction （STEMI） combined with J wave syndrome and the changes of plasma lysophosphatidic acid （LPA） levels in patients with STEMI combined with ischemic J wave and to provide basis for early warning and antithrombotic therapy. Methods One hundrd and twenty-eight patients with STEMI which received coronary angiography were enrolled. The patients were divided into two groups, one group with J wave, the other group without J wave. One hundred and ten healthy people were choosed as controls. The relationships between clinical features electrophysiological fectures and serum LPA levels were analyzed. Results The incidence of Ischemic J wave was 29.7% in the patients with STEMI. The J wave group had higher incidence than non J wave group in right coronary atherosclerotic stenosis, acute inferior myocardial infarction, malignant ventricular arrhythmia. LPA levels were significantly increased in STEMI group （ 3.36 ± 0. 27 ） μmol/L comparing with controls [ （ 1.47 ± 0. 42） μmol/L, P 〈 0. 01 ]. LPA levels were significantly increased in J wave group （3.95 ±0. 33 ） μ mol/L comparing with non J wave group [ （3.02 ± 0.41 ） μ mol/L, P 〈 0. 01 ]. Conclusions J wave may happen in the early hyperacute stage of STEMI. J wave usually occurs in inferior ventricular wall involved with right coronary atherosclerotic stenosis and is accompanied with ventricular arrhythmia. The plasma LPA level is significantly elevated in STEMI, and especially in patients STEMI combined with ischemic J wave. LPA may play an important role in the pathogenesis of STEMI and J wave electrocardiographic mechanism. Ischemic J wave appearing and LPA level may be useful markers for the warning and intervention of STEMI.