溶栓治疗对老年急性心肌梗死患者血清Ⅲ型前胶原末端肽及左心功能的影响

A study on serum concentration of pro collagen Ⅲ and left ventricular function in acute myocardial infarction with or without thrombolytic therapy in elderly patients

目的 观察溶栓与非溶栓治疗对老年急性心肌梗死 (AMI)患者血清Ⅲ型前胶原水平及左心功能的影响。 方法 将 38例AMI患者分为静脉溶栓组 (2 1例 )和非溶栓组 (17例 ) ,应用放射免疫法测定血清Ⅲ型前胶原末端肽 (PⅢP)含量 ,采用彩色Doppler超声心动图仪测量左室结构及舒缩功能参数。 结果 溶栓组患者在溶栓开始后 1、2、4、6周血清PⅢP含量分别为 (94 35± 11 32 )、(92 2 6± 10 18)、(89 2 4± 8 92 )和 (86 44± 7 98) μg/L ,较同期非溶栓组患者PⅢP(12 4 30± 9 77)、(12 7 6 0± 11 87)、(10 9 80± 10 96 )和 (96 2 0± 9 17) μg/L明显降低 (P <0 0 5或P <0 0 1) ;溶栓未再通组血清PⅢP含量显著高于再通组 (P <0 0 5或P <0 0 1)。血清PⅢP含量与左室重塑 (LVRM)程度有良好的相关性 (r=0 375 1,P <0 0 5 ) ,与左室舒缩功能呈负相关 (r =- 0 485 7,P <0 0 5 ;r =- 0 45 6 8,P <0 0 5 )。 结论 早期实施静脉溶栓治疗能降低血清PⅢP水平 ,减少LVRM发生 ,改善左心功能。

Objective To examine the serum concentration of pro collagen Ⅲ(PⅢP) and left ventricular function in acute myocardial infarction (AMI) patients with or without thrombolytic treatment. Methods The 38 patients with AMI were randomly divided into thrombolysis group (n=21) and non thrombolysis group (n=17). The serum concentration of PⅢP were measured by specific radioimmunoassay. Two dimensional, M mode and Doppler ultrasound recordings were obtained from all patients to determine serveral parameters relating to the left ventricular anatomy and function. Results In comparison with non thromblysis group at 1st, 2nd, 4th, 6th week after treatment, serum concentrations of PⅢP was significantly decreased in patients of thrombolysis group 〔(94 35±11 32),(92 26±10 18),(89 24±8 92),(86 44±7 98)μg/L vs (124 30±9 77),(127 60±11 87), (109 80±10 96),(96 20±9 17)μg/L, P<0 05 or P<0 01〕. PⅢP was significantly increased in non reperfusion group than that of the reperfusion group. PⅢP was correlated positively with left ventricular remodeling (LVRM) (r=0 3751, P<0 05), and negatively with the left ventricular diastolic and systolic function (r=-0 4857 , P<0 05; r=-0 4568, P<0 05). Conclusions The early intravenous thrombolytic therapy improves left ventricular function, and decreases serum PⅢP and reduces LVRM.