糜蛋白酶/血管紧张素2通路激活对急性前壁心肌梗死患者PCI围术期左室重构的影响

Effect of Chymotrypsinangiotensin-2 Pathway Activation on Left Ventricular Remodeling in Patients with Acute Anterior Myocardial Infarction during Perioperative PCI

目的:观察血浆糜蛋白酶/血管紧张素2(Ang2)通路激活在急性前壁心肌梗死PCI再灌注前后水平变化情况及患者左室功能变化情况,以评估糜蛋白酶/Ang2通路激活在PCI围手术期与左室重构的相关性。方法:选取2016年1月-2017年12月本院收治的急性前壁心肌梗死患者60例。根据前降支血流TIMI分级将其分为完全闭塞组31例与次全闭塞组29例。两组均行冠状动脉造影及PCI术,检测PCI围术期的糜蛋白酶、ACE2、Ang1、Ang2及左室重构指标(LVEF、LVEDV),分析上述生化指标与左室重构的关系。结果:在围术期,完全闭塞组Ang1、Ang2、糜蛋白酶、ACE2水平均高于次全闭塞组,比较差异均有统计学意义(P<0.05),术后即刻在PCI开通血管后,Ang1、Ang2、糜蛋白酶、ACE2水平均迅速降低,术后1周又均有所回升;PCI手术前后Ang2、糜蛋白酶均与LVEF、LVEDV密切相关(P<0.05),且呈现线性回归;ACE2仅在术前与心肌重构指标相关(P<0.05),术后ACE2这一相关性消失(P>0.05)。结论:PCI术前血浆糜蛋白酶、ACE2、Ang1和Ang2均高于术后即刻,证实了早期PCI手术再灌注获益来源于对内分泌因子的调控,而且在急性前壁心肌梗死PCI围术期糜蛋白酶与Ang2水平均与左心室重构高度相关,而此相关性独立于ACE2水平。

Objective：To observe the changes of plasma chymotrypsin/angiotensin-2（Ang2） pathway activation before and after reperfusion and left ventricular function in patients with acute anterior myocardial infarction,to evaluate the correlation between activation of chymotrypsin/Ang2 pathway and left ventricular remodeling during perioperative PCI.Method：A total of 60 patients with acute anterior myocardial infarction in our hospital from January 2016 to December 2017 were selected.According to the TIMI classification of the descending descending artery,they were divided into complete occlusion group（n=31） and subtotal occlusion group（n=29）.Coronary angiography and PCI were performed in two groups,and the indexes of chymotrypsin,ACE2,Ang1,Ang2 and left ventricular remodeling（LVEF,LVEDV） during the perioperative period of PCI were measured,and the relationship between the above biochemical indexes and left ventricular remodeling was analyzed.Result：During the perioperative period,the levels of Ang1,Ang2,chymotrypsin and ACE2 in complete occlusion group were all higher than those of subtotal occlusion group,the differences were statistically significant（P〈0.05）,immediately after operation of PCI,the blood vessels were opened,the levels of Ang1,Ang2,chymotrypsin and ACE2 decreased rapidly,and all increased after operation 1 week.Ang2 and chymotrypsin before and after PCI were closely related to LVEF and LVEDV（P〈0.05）,and showed linear regression.ACE2 was only associated with myocardial remodeling index before operation（P〈0.05）,and the correlation of ACE2 after surgery disappeared（P〈0.05）.Conclusion：Before PCI,the plasma chymotrypsin,ACE2,Ang1 and Ang2 are all higher than the immediate postoperatively,it is confirmed that the benefit of early PCI surgery is derived from the regulation of endocrine factors,and the level of chymotrypsin and Ang2 in the perioperative period of acute anterior myocardial infarction are associated with the height of left ventricular remodeling,and the correlation is independent of ACE2 level.