AMI患者冠脉支架植入早期血清MIP-1α变化情况研究

Effects of Coronary Stent Implantation on the Expression of MIP-1α on Early-Stage AMI patients

【目的】观察急性心肌梗死（AMI）患者冠脉支架植入早期血清巨噬细胞炎性蛋白-1α（MIP-1α）变化，并分析早期MIP-1α水平与患者心功能指标的相关性。【方法】选择2012年6月至2015年6月本院收治的80例行经皮冠状动脉介入术（PCI）的AMI为观察对象，并根据其梗死类型分为ST段抬高组和非ST段抬高组，每组各40例。观察两组患者支架植入前后血清MIP-1α的水平；观察不同特征的AMI患者早期血清MIP-1α水平的差异；分析MIP-1α水平与患者术后心功能的相关性。【结果】支架植入前两组患者的MIP-1α水平无明显差别，植入后1h、6h、12h和24h时，两组患者血清MIP-1α水平均降低，且非ST段抬高组降低更明显（P〈0．05）；合并糖尿病、合并高血压、病变支数〉2支、侧支循环较差、累及分支的AMI患者术后6h血清MIP-1α水平较高，而不同年龄、性别的患者MIP-1α水平无明显差别；两组患者手术前每搏输出量（SV）、氨基末端B型脑钠肽（NT-proBNP）、肌钙蛋白（CTnI）、局部电压电位（LVPS）、左室射血分数（LVEF）水平无明显差异，手术后，两组患者的SV、LVPS、LVEF水平均升高，NT-proBNP、CTnI和hs-CRP水平均下降，而非ST段抬高组上述指标的改善较ST段抬高组更为明显（P〈0．05）；术后6h时的MIP-1α水平与SV、LVPS和LVEF显著负相关，与NT-proBNP和CTnI水平显著正相关（P〈0．05）。【结论】AMI患者在植入冠脉支架早期，MIP-1α水平呈下降趋势，且非ST段抬高的AMI患者降低更明显；血清Mip-1a水平与患者的心功能密切相关，可作为监测支架植入效果的参考指标。

[Objective]To observe the effects of coronary stent implantation on the expression of MIP-1α （macrophage inflammatory protein 1 aplha） in early-stage Acute Myocardial Infarction （AMI） patients and to ana- lyze the correlation between MIP-1α level and cardiac function in patients with early-stage AMI. [Methods]Eighty patients with AMI treated with PCI at our hospital from June 2012 to June 2015 were selected and divided into a ST segment elevation group and a non-ST segment elevation group, with forty patients in each group. The levels of MIP-1α in the two groups before and after stent implantation of serum and levels of MIP-1α in AMI patients with different characteristics were observed, and the correlation between MIP-1α level and cardiac function in patients with postoperative cardiac function was analyzed. [Results] There was no significant difference in the levels of MIP-1α between the two groups before implantation, however, 1h, 6h, 12h, and 24h after implantation,the levels of MIP-1α in the two groups all decreased. The reduction of non-ST segment elevation group was even more signif- icant（ P 〈0.05）. The levels of MIP-1α in patients with diabetes combined with hypertension, lesion count 〉2 branches, or poor collateral circulation were higher, while patients of different ages and genders showed no signifi- cant difference. The levels of hs-CRP, NT-proBNP, LVEF, CTnI, LVPS, and SV in the two groups before treat- ment showed no significantly difference. After treatment, the levels of LVPS, LVEF, and SV in the two groups increased and the levels of CTnI and NT-proBNP decreased; the improvement in the non-ST segment elevation group was more obvious than that of the ST segment elevation group. The levels of MIP-I~ 6h after implantation was significantly negatively correlated with SV, LVPS and LVEF levels and significantly positively correlated with NT-proBNP and CTnI levels（ P 〈0.05）. [Conclusion]At the early stage of coronary stent implantation, the levels of MIP-1α in AMI patients decreased, especially on non-ST segment elevation patients. The level of MIP-1α is closely related with the heart function of patients, which can be used as a reference index for monitoring the effect of the implant.