心肌梗塞溶栓治疗对某些神经内分泌递质的影响  

Effects of thrombolysis for acute myocardial infarction on plasma neurohormones

作　　者：陈步星[1] 徐成斌[1] 吴彦[1] 王伟民[1] 蒋宝琦[1] 李彤妹[1] 祁瑞环[1] 

机构地区：[1]北京医科大学人民医院心内科

出　　处：《中华内科杂志》1998年第1期24-26,共3页Chinese Journal of Internal Medicine

摘　　要：目的探讨急性心肌梗塞患者早期冠状动脉（冠脉）再灌注对循环中内皮素、心钠素及肾素－血管紧张素系统的影响。方法接受静脉溶栓治疗的３１例急性心肌梗塞（ＡＭＩ）患者在发病后１２、２４、４８小时、第７及１４天分别取血测定血浆中内皮素、心钠素、肾素、血管紧张素Ⅱ、醛固酮及血管紧张素转换酶。依冠脉早期再灌注指标，将患者分为再灌注组（Ａ组）和非再灌注组（Ｂ组）。比较两组患者血中神经内分泌递质的动态变化。并设正常对照组（Ｃ组）。结果ＡＭＩ后患者血浆内皮素、心钠素、血管紧张素Ⅱ及醛固酮均明显高于Ｃ组。Ａ组患者血浆内皮素水平明显低于Ｂ组（７１．１９±７０．１５ｎｇ／Ｌ对８８．５９±１１．０４ｎｇ／Ｌ，Ｐ＜０．０１）。ＡＭＩ后２周，Ａ组内皮素已降至正常，而Ｂ组仍高于Ｃ组（５７．０７±９．６２ｎｇ／Ｌ对４６．０４±８．１３ｎｇ／Ｌ，Ｐ＜０．０１）。Ａ组血浆心钠素在ＡＭＩ后２周恢复正常，而Ｂ组心钠素在ＡＭＩ后２周仍高于Ｃ组（１７８．５３±４９．９１ｎｇ／Ｌ对１３１．４４±３８．７９ｎｇ／Ｌ，Ｐ＜０．０５）。ＡＭＩ后血浆肾素活性高于对照组，Ｂ组高于Ａ组，但三组之间差异无显著性。三组之间血浆血管紧张素转换酶差异无显著性。ＡＭＩ后Ａ组血浆血?Objective To evaluate the effects of early reperfusion after thrombolysis in acute myocardial infarction (AMI) on plasma endothelin (ET), atrial natriuretic peptide (ANP), and renin angiotensin system. Methods The plasma concentrations of ET, ANP, renin (PRA), angiotensin converting enzyme (ACE), angiotensin Ⅱ(AⅡ), aldosterone (ALD) at the time of 12 hours, 24 hours, 48 hours, 7 days and 14 days after AMI being treated with thrombolysis were measured. According to clinical early reperfusion parameters, thirty one AMI patients were divided into two groups, 19 with reperfusion group (group A) and 12 non reperfusion (group B). Thirteen of group A were confirmed TIMI Ⅲ flow, and 7 of group B TIMI 0～Ⅰ flow by coronary angiography. Fifteen healthy individuals were served as controls (group C). Results The plasma concentrations of ET, ANP, AⅡ and ALD in AMI patients were significantly higher than those controls. The level of ET in group B was significantly higher than that in group A (88.59±11.04 ng/L vs 71.19±70.15 ng/L, P <0.01). Two weeks after AMI, the concentration of ET in group A returned to normal and that in group B was still higher than group C (57.09±9.62 ng/L vs 46.04±8.13 ng/L, P <0.01). The level of ANP in group A was normal 2 weeks after AMI and that in group B was still significantly increased (178.53±49.91 ng/L vs 131.44±38.79 ng/L, P <0.05). The renin activity in AMI cases was higher than the controls, and that in group B was higher than group A, but without siginificance. Whether group A or group B, the plasma level of ACE was not different between group A and B. Two weeks after AMI, the plasma levels of AⅡ with group A and group B remained elevated, but the latter was significantly higher than the former (117.87±32.64 ng/L vs 86.25±28.43 ng/L, P <0.01). The level of ALD in group A was normal 1 week after AMI and that in group B was normal 2 weeks after AMI. Conclusion The plasma neurohormones were activated after AMI. Duration of neurohormal activation in non

关 键 词：心肌梗塞 心肌再灌注 内皮缩血管肽 治疗 

分 类 号：R542.220.5[医药卫生—心血管疾病]