血清醛固酮和急性ST段抬高型心肌梗死经皮冠状动脉介入术后无复流的关系  

Association of serum aldosterone level at admission with no-reflow phenomenon in patients presenting with acute ST-elevation myocardial infarction

作　　者：龚兴荣[1] 何奔[1] 乔志卿[1] 张清[1] 葛恒[1] 何清[1] 韩志华[1] 厉锦华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海市200001

出　　处：《中国介入心脏病学杂志》2008年第4期204-207,共4页Chinese Journal of Interventional Cardiology

基　　金：上海市科委登高重点课题(064119501);浦东新区重大协作课题(PW2006D-3)

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)急诊PCI术前血清醛固酮(aldosterone,ALDO)水平和术后无复流的关系。方法2007年1月至2007年10月连续收集117例STEMI患者,在发病12h内行急诊PCI,在术前股动脉穿刺后留取血清,采用放射免疫法测定醛固酮含量。按ALDO水平分成三组,ALDO<100pg/mL组37例,100pg/mL≤ALDO≤200pg/mL组43例,ALDO>200pg/mL组37例。PCI术后通过评估冠状动脉血流TIMI分级,来判断无复流的发生。又将117例分为无复流(10例)和心肌充分复流(107例)两组,比较两组ALDO水平。结果ALDO>200pg/mL组的无复流发生率(21.62%)明显高于ALDO<100pg/mL组(2.70%)和100pg/mL≤ALDO≤200pg/mL组(2.33%),P=0.0038。另外,无复流组ALDO水平为379.1±234.3pg/mL,明显高于心肌充分复流组的164.5±100.6pg/mL(P=0.0010)。STEMI发病早期PCI术前的ALDO水平与术后TIMI分级两者呈负相关(相关系数-0.39241,P<0.0001)。结论随着血清醛固酮水平的升高,无复流的发生也相应增加。STEMI发病早期PCI术前的ALDO水平与术后TIMI分级两者呈负相关。Objective To investigate the association of serum aldosterone level （ALDO） at admission in patients presenting with STEMI within 12 hours of symptom onset with no-reflow phenomenon after PCI. Methods The study included 117 consecutive patients admitted into our hospital from January to October, 2007 who had received primary PCI for acute STEMI within 12 hours of symptom onset. Blood samples were drawn through the femoral arterial sheath before coronary intervention from all patients in supine position （ mean time ± sd 5.74 ± 2. 47 hours ） and serum aldosterone levels were measured by radioimmunoassay. Results No-reflow phenomenon was found in 10 patients after PCI. The incidence of no-reflow was higher in patients with ALDO 〉 200 pg/mL （n = 37） compared with patients with ALDO 〈 100 pg/mL （n=37） and patients with 100 pg/mL≤ALDO≤200 pg/mL （n =43） （21.62% vs 2.7% and 2. 33%, P = 0. 003 8）. The mean ALDO level was higher in patients who had no-reflow phenomenon compared with patients whose blood flow restored after PCI （ 379. 1 ± 234. 3 pg/mL vs 164. 5 ± 100. 6 pg,/mL, P =0. 001 0）. The aldosterone level was inversely correlated with post-PCI TIMI grade （ r = - 0. 392 41 ,P 〈 0. 000 1 ） by regressional test. Conclusion Serum aldosterone level is associated with an increase incidence of no-reflow phenomenon. The aldosterone level is inversely correlated with post-PCI TIMI grade.

关 键 词：心肌梗死 醛固酮 心肌再灌注 

分 类 号：R581.102[医药卫生—内分泌] R542.22[医药卫生—内科学]