急性ST段抬高心肌梗死患者再灌注损伤性心电图改变与炎症及氧化应激的关系

Association Reperfusion Injury Electrocardiogram Changes with Inflammation and Oxidative Stress in Patients with Acute ST Segment Elevation Myocardial Infarction

目的探讨急性ST段抬高心肌梗死患者再灌注损伤性心电图改变特点及其与炎症、氧化应激的关系。方法将80例成功实施经皮冠状动脉介入治疗(PCI)后再通的急性ST段抬高心肌梗死患者,根据心电监测结果分为再灌注损伤性心电图改变组(n=48)和无再灌注损伤性心电图改变组(n=32),采用ELISA检测血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)浓度,同时测定血清中丙二醛(MDA)含量及超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)活性。结果 PCI术后再通的急性ST段抬高心肌梗死患者再灌注损伤性心律失常的发生率高(60.00%),且以加速性室性自主心律最多见,并易伴随再灌注损伤性ST段抬高(36.25%)。与无再灌注损伤性心电图改变组比较,再灌注损伤性心电图改变组血清TNF-α、IL-1β、IL-6浓度及MDA含量明显升高(P<0.01),而血清SOD、GSH-Px、CAT活性显著降低(P<0.01)。结论急性ST段抬高心肌梗死患者再灌注治疗后易于发生再灌注损伤性心电图改变,其机制可能与再灌注后炎症反应加重及氧自由基生成增多有关。

Objective To explore the characteristics of reperfusion injury electrocardiogram changes and their asso-ciation with inflammation and oxidative stress in patients with acute ST segment elevation myocardial infarction. Methods Eighty acute ST segment elevation myocardial infarction patients who had been unobstructed by percutaneous coronary inter-vention （PCI） were divided into reperfusion injury electrocardiogram change group （n=48） and without reperfusion injury electrocardiogram change group （n=32） according to the results of electrocardio monitoring. The concentrations of tumor necrosis factor-α （TNF-α）,interleukin-1β （IL-1β） and interleukin-6 （IL-6） were detected by ELISA. Serum contents of malondialdehyde （MDA） and activities of superoxide dismutase （SOD）,glutathione-peroxidase （GSH-Px） and catalase （ CAT） were examined. Results The incidence of reperfusion injury arrhythmia was 60. 00%,especially accelerated id-ioventricular rhythm,and that of reperfusion injury ST segment elevation was 36. 25% in patients with acute ST segment ele-vation myocardial infarction. In comparison with without reperfusion injury electrocardiogram change group,Serum TNF-α, IL-1β and IL-6 concentrations as well as MDA content were significantly increased （P〈0. 01） while serum activities of SOD,GSH-Px and CAT were significantly decreased （P 〈0. 01）. Conclusion Reperfusion injury electrocardiogram changes are prone to occur in patients with acute ST segment elevation myocardial infarction after PCI. The mechanisms are＆amp;nbsp;involved in aggravated inflammatory reaction and enhanced production of oxygen free redicals after reperfusion.