缺血后适应对急性心肌梗死患者心脏的保护作用

Effect of ischemic postconditioning on prognosis in acute myocardial infarction patients

目的探讨缺血后适应对心脏产生保护作用及与氧自由基和炎症反应的关系。方法选取我院急性ST段抬高型心肌梗死(STEMI)患者42例,随机分为对照组(A组,n=22例)和缺血后适应组(B组,n=20例)。记录两组患者临床基本特征、冠脉病变情况以及支架置入情况;PCI术前、术后2 h、1、2、3 d抽取动脉血2 mL送我院检验科生化室检测血清肌酸激酶同工酶(CK-MB)水平;术前及术后2 h抽取动脉血2 mL离心、保存于-80℃冰箱,待标本收集完后采用酶联免疫吸附测定法(ELISA)法检测血清丙二醛(MDA)、超氧化物歧化酶(SOD)及C反应蛋白(CRP)的水平。结果两组患者临床基本特征、冠脉病变情况及支架置入情况比较无差异。B组术后2 h血清MDA下降较A组明显(P<0.05),而B组血清SOD升高较A组明显(P<0.001),Pearson相关分析发现B组SOD和MDA的变化呈负相关(r=-0.438,P=0.04),而A组呈正相关(r=0.301,P=0.05);B组术后2 h血清CRP值升高幅度明显低于A组(P<0.05),Pearson相关分析发现B组术后血清CRP伴随血清CK-MB下降幅度较A组明显(r=0.187,P<0.01)。结论缺血后适应通过降低STEMI患者直接PCI时氧自由基产生以及抑制炎症反应,对心脏发挥保护作用。

Objective To investigate the relationship between ischemic postconditioning to produce protective effects on the heart with oxygen free radicals and inflammatory responses. Methods Forty - two acute myocardial infarction （AMI） patients admitted to our hospital were randomly divided into control group （ n = 22） and ischemia postconditioning group （n = 20） . Basic clinical characteristics, coronary artery lesions and stent implantation of the two groups of patients were recorded ; arterial blood （2 ml） was drawn and sent to the hospital laboratory monitoring serum CK -MB value by automatic biochemical analyzer. Serum levels of CRP, MDA and SOD were measured before and 2 h after PCI by ELISA . Results Basic clinical characteristics , coronary artery lesions and stent implantation of the two groups of patients were not statistically significant. CK - MB value was significantly lower in ischemic postconditioning group than in control group before and 2 h, 1,2,3 days after PCI , but was not statistically significant. Serum levels of CRP and MDA were significantly lower while the serum SOD level was significantly higher in ischemic postconditioning group than in control group （ P 〈 0.05, P 〈 0. 01 ）. Conclusion Ischemic postconditioning can reduce oxygen free radical levels and inhibit inflammatory reaction in AMI patients,thus playing a role in protecting the heart.