急性心肌梗塞患者血浆内皮素变化及其与病情的关系

CLINICAL SIGNIFICANCE OF THE PLASMA ENDOTHELIN LEVEL IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

用特异性放射免疫法检测了急性心肌梗塞(AMI)和心绞痛(AP)患者不同病期血浆内皮素(ET)的浓度。结果显示,AMI的血浆ET水平在入院后即刻升高达峰值(40.77±2.304pg/ml),第1天开始逐渐下降,至恢复期(第28天)仍较高(14.14±1.456pg/ml);不同时期的ET浓度依次为AMI组>AP组(25.63±2.285pg/ml)>对照组(6.35±0.441pg/ml),P<0.001。提示组织在缺血、缺氧状态下引起ET的大量释放,是机体释放的一种内原性致损伤因子。AMI早期血浆ET浓度与血清肌酸激酶(CK)的活力变化一致,故ET水平可做为AMI早期诊断的敏感指标之一。梗塞范围越大、有严重心律失常时血浆ET水平升高越明显;并发泵衰竭死亡者,死者ET持续升高,显示血浆ET水平升高的幅度与心肌病变的严重程度密切相关。硝酸甘油与硝苯吡啶可能有部分抑制ET的缩血管和心脏效应。

Endothelin (ET) is a recently discovered bioactive peptide produced by vascular endothelial cells. By means of specific radioimmunoassay plasma ET level was determined in 34 cases of acute myocardial infarction (AMI) and 12 cases of angina pectoris (AP). The levels of plasma ET in patients with AMI (40.77±2.304pg/ml) and AP (25.63±2.285pg/ml) were significantly elevated at compared with that of normal subjects (6.35±0.441pg/ml, P<0.05, 0.001). The result also showed that plasma ET level reached its peak value immediately after AMI and AP attack, and it fell gradually on the first day.It was found that the level of plasma ET was closely correlated with the seriousness of myocardial damage and arrhythmias. Therefore, plasma ET level may be considered as one of the sensitive indices of early diagnosis of AMI. It has also certain clinical value in the judgement of the extent of infarction and of prognosis.