急性心肌梗死微血管阻塞时冠状动脉血流及肌酸激酶改变的研究

Study on the coronary reperfusion and changes of serum creatine kinase in acute myocardial infarction with microvascular obstruction

目的 探讨急性心肌梗死 (AMI)合并梗死区微血管阻塞 (microvascularobstruction ,MO)时冠状动脉血流、血清肌酸激酶 (CK)及MB同工酶改变的特点及意义。方法 对 10例核磁共振成像 (MRI)诊断为AMI合并MO患者的心肌酶学等临床资料进行回顾性分析 ,并与 12例单纯AMI患者进行比较研究。结果 ①AMI合并MO组冠状动脉再灌注的比例少于非MO组 (冠状动脉血流TIMI 3级 ;梗死后 :0 %比 4 1 7% ,P=0 0 30 ;MRI检测前 :5 0 0 %比 75 0 % ,P=0 173)。②MO组血清CK和MB峰值活力显著高于非MO组〔CK :(14 11 1± 92 8 3)U/L比 (84 5 2± 837 1)U/L ,P =0 0 5 0 ;MB :(11 7± 6 1) %比 (7 2±3 4 ) % ,P =0 0 4 3)〕。③MO组血清CK峰值大于 10 0 0U/L占 70 0 % (7/ 10 ) ,高于非MO组 (33 3% ,4 / 12 ,P =0 194 )。④合并MO患者单位梗死面积的CK峰值释放大于 5 0 0 0U/L的比例低于非MO组〔(2 0 0 % (2 / 10 )比 5 8 3% (7/ 12 ) ,P =0 0 72〕。结论 AMI患者合并MO时冠状动脉再灌注的比例较低 ,心肌酶峰值活力增高 ,但单位梗死面积的心肌酶释放减少。

Objective To evaluate the serum creatine kinase(CK) and MB isoenzyme characteristics in acute myocardial infarction(AMI)with microvascular obstruction (MO).Methods The coronary reperfusion,serum CK and MB isoenzyme activities were measured in 10 patients with AMI and MO detected by contrast-enhanced magnetic resonance imaging and compared with 12 simple AMI cases without MO.Results There was less coronary reperfusion frequency in AMI patients with MO compared with simple AMI group(coronary angiogram TIMI 3:after AMI 0 vs.41.7%,P=0 030;before MRI 50.0% vs.75 0%,P=0 173).The peak activities of CK and MB isoenzyme in MO group were significantly higher than that of simple AMI group[CK:(1 411 1±928 3)U/L vs.(845 2±837 1)U/L,P=0 050;MB:(11 7±6 1)%vs.(7 2±3 4)%,P=0 043] The frequency of CK peak activity not less than 1 000 U/L in MO group was 70%(7/10),and was higher than that in non-MO group(33 3%,4/12,P=0 194) The ratio of CK peak over infracted size (larger than 5 000 U/L) in MO group was less than non-MO group (20 0%,2/10 vs.58 3%,7/12;P=0 072).Conclusion Higher cardiac enzyme peak and less coronary reperfusion frequency were found in MO patients and cardiac enzyme release might be decreased around the infarction area.