心肌内出血与心肌梗死后不良心室重构的关系研究进展

Relationship between intramyocardial hemorrhage and adverse ventricular remodeling after myocardial infarction

心肌梗死是由心肌缺血缺氧引起的心肌细胞坏死,是全球范围内死亡和致残的重要原因。直接经皮冠状动脉介入治疗虽然可恢复心外膜冠脉血流,降低心肌梗死的病死率,但是部分心肌梗死患者仍会发展为慢性心力衰竭。心肌内出血(IMH)为严重微血管损伤引起的红细胞外渗,是再灌注治疗引起的重要并发症,可作为心肌梗死后不良心室重构的独立预测因子,而不良重构是心肌梗死后心力衰竭发生的病理基础。目前IMH的评价方式主要为心脏磁共振技术,尤其是可利用T;*序列实现对IMH的定性和定量评估。有研究表明,IMH被降解后留下的铁沉积可加重炎症反应,导致巨噬细胞聚集,分泌基质金属蛋白酶,而后者参与了随后的不良心室重构过程。本文针对近年来关于IMH与心肌梗死后不良心室重构关系的临床和基础研究进展进行综述,旨在为心肌内出血的防治提供参考。

Myocardial infarction (MI) is cardiomyocyte necrosis caused by myocardial ischemia and hypoxia,and is the leading cause of death and disability in the world.Although direct percutaneous coronary intervention (PCI) can restore epicardial coronary blood flow and reduce the mortality of MI,some patients with MI will still develop into chronic heart failure.As an important complication caused by reperfusion therapy,intramyocardial hemorrhage (IMH) is defined as red blood cell extravasation caused by severe microvascular injury,and can be used as an independent predictor of the adverse ventricular remodeling after myocardial infarction,which is the pathological basis of heart failure after myocardial infarction.At present,the main evaluation method for IMH is cardiac magnetic resonance imaging (MRI),especially the qualitative and quantitative evaluation of intracardial bleeding can be achieved by T;* sequence.It has been shown that iron deposition after degradation of IMH exacerbates the inflammatory response,leading to the aggregation of macrophages and secretion of matrix metalloproteinases,which are involved in subsequent adverse ventricular remodeling.The recent progress of clinical and basic research on the relationship between IMH and the adverse ventricular remodeling after MI are reviewed in present paper,hoping to be helpful for the prevention and treatment of IMH in the future.