经皮冠状动脉腔内成形术后心肌酶增高的因素探讨

The investigation of the factors leading myocardial enzymes elevations after percutaneous interventions

目的:探讨经皮冠状动脉腔内成形术(PTCA)及冠状动脉内支架术治疗后心肌酶(CK、CK-MB)增高的原因。方法:用常规生化方法测定CK、CK-MB。选择92例PTCA及冠脉内支架术前CK、CK-MB值正常的患者,术后6～8h及24h再次测定CK、CK-MB值。将测定值高于正常范围的患者列入增高组(n=20),测定值在正常范围内的为正常组(n=72)。结果:92例患者术前CK、CK-MB均在正常范围[分别为(73.2±34.7)U/L和(10.5±4.3)U/L]。两组间病变复杂程度(多支病变)在心肌酶增高组[CK和CK-MB分别为(252±60.8)U/L和(46.5±13.1)U/L]较为明显,而在心肌酶正常组[CK和CK-MB分别为(82.3±46.5)U/L和(12.4±3.1)U/L]病变较轻,差异有统计学意义(χ2=4.09P<0.05)。冠脉边支闭塞、大于20min的胸痛及冠脉撕裂两组间比较差异有统计学意义(P均<0.05)。结论:PTCA及冠脉内支架治疗后部分患者CK、CK-MB值增高的原因可能是多支复杂病变,冠脉撕裂,特别是边支闭塞、栓塞导致心肌细胞的损伤或小灶性坏死。

Objective:To investigate the factors inducing myocardial enzymes elevations after percutaneous transluminal coronary angioplasty and intracoronary stent.Methods:92patients were ob-served.Their myocardial enzymes(creatine kinase,CK and CK-MB)levels were detected before and af-ter undergoing successful percutaneous transluminal coronary angioplasty(PTCA)or PTCA+Stent.The patients were divided into two groups according to their peak CK and CK-MB levels(higher than nor-mal and normal)after the procedure.20patients were higher(group1),and72patients normal(group2).Results:The myocardial enzymes of92patients were all normal[CK and CK-MB,(73.2±34.7)U/L and(10.5±4.3)U/L respectively]before the operation.The complex or multivessels lesions were significantly heaver in group1[CK and CK-MB,(252±60.8)U/L and(46.5±13.1)U/L respectively]than in group2[CK and CK-MB,(82.3±46.5)U/L and(12.4±3.1)U/L respectively](P<0.05).There were significant dif-ferences in prolonged chest pain(>20minutes)(P<0.01),sidebranch occlusion(P<0.005),coronary lacer-ation(P<0.05)between two groups.Con clusion:This study shows that elevation of myocardial enzymes after successful coronary interventions may be associated with the multivessel procedure,coronary lacer-ation and sidebranch occlusion.These factors lead to the damage of myocardial cell or /and minor my-ocardial necrosis.