心肌梗死前心绞痛对再灌注治疗后心肌微血管功能的影响

Influence of Preinfarction Angina on Microvascular Function After Reperfusion Therapy

目的 :探讨心肌梗死前心绞痛对再灌注治疗后心肌微血管功能的影响 ,从心肌微循环灌注角度阐明梗死前心绞痛的意义。 方法 :2 4例急性心肌梗死病人分为有梗死前心绞痛 (AP)组 (AP组 ,13例 )和无梗死前心绞痛组 (无AP组 ,11例 )。所有病人在症状开始后 6小时内接受经皮冠状动脉腔内成形术及支架置入术 ,术后 12小时内行静脉心肌声学造影 ;监测心肌酶谱变化。 结果 :两组病人基本临床情况无显著差异 (P >0 0 5 )。有AP组与无AP组肌酸激酶峰值分别为 1880± 2 60U/L、2 3 5 7± 3 81U/L (P <0 0 1) ,肌酸激酶MB同工酶峰值分别为 3 84± 5 4U/L、 5 3 1± 5 7U /L (P <0 0 1) ;室壁运动积分分别为 1 0 1± 1 0 4、 1 2 3± 0 44 (P <0 0 5 ) ,左心室射血分数分别为 0 61± 0 13、 0 43± 0 11(P <0 0 1) ;心肌声学造影积分分别为 1 2 3± 0 44、 1 91± 1 0 4(P <0 0 5 ) ,标化A×B值分别为 0 81± 0 2 3、 0 46± 0 3 5 (P <0 0 1) ,均有显著性差异。 结论 :有微血管损伤的急性心肌梗死病人 ,其心肌损伤严重 ,心功能较差 ;梗死前心绞痛通过预适应效应限制心肌损伤 ,有利于心肌存活、心功能恢复及心肌微血管完整性的保存。因而 ,梗死前心绞痛不仅对心肌有保护作用 。

Objective:To investigate the influence of preinfarction angina on microvascular function,and to illustrate the implication of preinfarction angina according to the microvasculation perfusion level. Methods:Twenty four patients with acute myocardial infarction(AMI)were divided into pre infartion angina pectoris group(AP group,n=13) or non preimfarction angina pectoris group(n AP group n=11).All patients underwent percutaneous transluminal coronary angioplasty(PTCA)or stent implantation within 6 hours after AMI attacks,and intravenous myocardial contrast echocardiography was performed within 12 hours after PTCA or Stenting.Myocardial enzymes were measured. Results:There were no significant differences in clinical characteristics between groups(p>0 05).The value of reatine kinase (CKmax) was 1*!880±260*!U/L in AP group and 2*!357±381*!U/L in n AP group(p<0 01).The value of CK MBmax was 384±54*!U/L and 531±57*!U/L(p<0 01),respectively.The wall motion scores were 1 01±1 04 versus 1 23±0 44 (p<0 05) The value of left ventricular ejection fraction (LVEF) was 0 61±0 13 versus 0 43±0 11(p<0 01).The MCE scores were 1 23±0 44 versus 1 91±1 04(p<0 05),and the normalized A×B value was 0 81±0 23 versus 0 46±0 35(p<0 01). Conclusion:After acute myocardial infarction,patients with microvascular damage suffer more serious myocardial injury and poorer myocardial function.Preinfarction angina,because of its preconditioning effect,limits myocardial damage,favors myocardial viability and function recovery and intact microvascular integrity,preinfarction angina has a protective effect not only myocardium,but also on microcirculation.