心肌梗死前心绞痛病史时程对梗死面积的影响及再灌注治疗的作用

Effect of duration of preinfarction angina on infarct size and reperfusion

目的 探讨心肌梗死前心绞痛病史时程对梗死面积的影响及再灌注治疗在其中的作用。方法 381例首次发作急性心肌梗死患者 ,分组比较发病前心绞痛和既往心绞痛对肌酸激酶 (CK)和肌酸激酶同工酶 (CK MB)峰值及Wagner心电图QRS记分值的影响 ,并观察早期再灌注治疗的作用。 结果 ①分组 :381例患者中 ,仅有发病前心绞痛者 77例 (A组 ,占 2 0 .2 % ) ,仅有既往心绞痛者 130例 (B组 ,占 34.1% ) ,兼有发病前心绞痛和既往心绞痛者 73例(C组 ,占 19.2 % ) ,心肌梗死前无心绞痛者 10 1例 (D组 ,占 2 6 .5 % )。②CK、CK MB峰值及QRS记分值 :A组、B组和C组显著低于D组 (P均 <0 .0 5 ) ;③再灌注对CK、CK MB峰值及QRS记分值的影响 :各组内有再灌注 (+)亚组显著低于无再灌注 (- )亚组 (P均 <0 .0 0 1)。A(+)亚组和C(+)亚组显著低于D(+)亚组 (P均 <0 .0 5 ) ,而B(+)亚组和D(+)亚组间比较差异无统计学意义 (P均 >0 .0 5 )。B(- )亚组和C(- )亚组均显著低于D(- )亚组 (P均 <0 .0 5 ) ,而A(- )亚组和D(- )亚组间差异均无统计学意义 (P均 >0 .0 5 )。结论 既往心绞痛可明显保护严重缺血的心肌 ,减少梗死面积 ,其作用不依赖于再灌注治疗 ,可能与侧支循环形成有关 ;而发病前心绞痛可能通过缺血预适应机制延长心肌对严重?

Objective To investigate the effects of the duration of preinfarction angina on infarct size and reperfusion.Methods Three hundred and eighty-one patients with first acute myocardial infarction,the relation of previous angina and prodromal angina to peak creatine kinase(CK) and creatine kinase-MB enzyme(CK-MB) and Wagner QRS score of ECG were analyzed separately,and the influence of reperfusion was also analyzed.Results ①In the 381 patients,there were 77 patients with only prodromal angina (group A, 20.2%),130 patients with only previous angina (group B, 34.1%),73 patients with both prodromal and previous angina (group C, 19.2%) and 101 patients without any angina (group D, 26.5%).Each group was further divided into two subgroups according to the therapy: those with reperfusion within 6 hours [(subgroup(+)] and those without reperfusion within 6 hours [subgroup(-)].②The peak CK and CK-MB and QRS score were significantly lower in group A,B and C than those in group D (P< 0.05).③The influence of reperfusion: In each group,CK,CK-MB peak value and QRS score were significantly lower in subgroup (+) than those in subgroup (-)(P< 0.001).The peak CK and CK-MB and QRS score were significantly lower in subgroup A (+) and subgroup C (+) than those in subgroup D (+)(P> 0.05),but there as no significant difference between subgroup B (+) and subgroup D(+).In subgroup B(-) and subgroup C(-),the peak CK,CK-MB and QRS score were significantly lower than those in subgroup D(-)(P< 0.05),but there were no significant difference between subgroup A(-) and subgroup D(-)(P> 0.05).Conclution Previous angina protects the ischemic myocardium and reduces infarct size by collateral circulation development and this effect is independent of reperfusion,prodromal angina also protects myocardium by decreasing the progression of myocardial necrosis resulting from ischemic preconditioning and the effect of reducing infarct size depend on the early reperfusion.