急性心肌梗死后前胶原及透明质酸的变化及氯沙坦的干预作用  

Change of serum procollagen type Ⅰ,Ⅲ,Ⅳ and hyaluronic acid in acute myocardial infarction patients and the effect of losartan on them

作　　者：朱伟达[1] 陈炼[1] 倪琦[1] 沈箐源[1] 陈雷旻[1] 朱鸣风[1] 

机构地区：[1]上海市第二人民医院心内科,上海200011

出　　处：《中国急救医学》2006年第9期661-663,共3页Chinese Journal of Critical Care Medicine

基　　金：上海市黄浦区软科学研究攻关项目(No.HGG-15)

摘　　要：目的观察血管紧张肽Ⅱ受体Ⅰ拮抗药(ARB)氯沙坦对急性心肌梗死(AM I)后血清Ⅰ、Ⅲ、Ⅳ型前胶原及透明质酸的影响,及对心功能、心腔大小的作用。方法选择我院住院AM I患者56例,随机分为两组,一组常规治疗,不用ACEI及ARB,另一组从AM I后当天开始服用氯沙坦,分别于AM I后当天、1周、1个月、3个月抽取静脉血,放免法测定血清Ⅰ、Ⅲ、Ⅳ型前胶原及透明质酸。AM I后1个月行心动超声检查,评价心功能,测定左室舒张末容积。结果AM I后血清Ⅰ、Ⅲ、Ⅳ型前胶原及透明质酸均升高,前胶原Ⅰ/Ⅲ型比例失调,且后者与心功能恶化呈正相关(r=0.856,P<0.05),与心腔扩张呈负相关(r=-0.730,P<0.05)。氯沙坦治疗很好地抑制了这一改变。结论血管紧张肽Ⅱ受体Ⅰ拮抗药氯沙坦抑制AM I后胶原重建过程,有利于维持心脏结构及保护心脏功能。Objective To observe the effect of angiotensin - Ⅱ type Ⅰ antagonist losartan on serum procollagen type Ⅰ （ PINP）, typeⅢ （ P Ⅲ NP）, type IV （ CL -Ⅳ ） and hyaluronic acid （HA） and heart function, left ventricular end - diastolic diameter in acute myocardial infarction（AMI） patients. Methods 56 patients suffered from acute myocardial infarction were divided into two groups randomly. One group accepted losartan 50 mg/d, the other did not. The serum procollagen typeⅠ , type Ⅲ, type Ⅳ, HA were measured at the first day, one week ,one month, three months after the myocardial infarction by radioimmunoassay. The heart ejection fraction and left ventricular end - diastolic diameter were measured at one month after the AMI. Result The procollagen type Ⅰ , type Ⅲ, type IV and HA were increased in AMI patients significantly and the ratio of procollagen type Ⅰ to type m was decreased and the latter was positively related with left ventricular ejection fraction （ r = 0. 856, P 〈 0. 05） and negatively related with left ventricular end- diastolic diameter（ r = -0. 730, P 〈0.05）. Losartan could control this change and has good effect on heart function. Conclusion Losartan can extracellular matrix from remodelling in AMI heart and have good effect on heart function.

关 键 词：急性心肌梗死 氯沙坦 Ⅰ、Ⅲ、Ⅳ型前胶原 透明质酸 

分 类 号：R542.22[医药卫生—心血管疾病]