多次发作梗死前心绞痛对预处理心肌保护作用影响的探讨  

Multiple episodes of preinfarction angina are not associated with loss of cardioprotection in preconditioning

作　　者：苏德淳[1] 王珂[1] 范书英[2] 常志文[3] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁大连116033 [2]北京中日友好医院心内科 [3]首都医科大学附属北京同仁医院干部医疗科

出　　处：《临床心血管病杂志》2009年第9期657-659,共3页Journal of Clinical Cardiology

基　　金：北京市教育委员会科技发展基金资助项目(No:KM200610025026)

摘　　要：目的:探讨多次发作的梗死前心绞痛能否减弱预处理对临床患者的心肌保护作用,为明确临床预处理耐受时间窗提供理论依据。方法:将2002～2005年急诊介入治疗的急性心肌梗死患者分为3组:组1(无心绞痛,55例)、组2(48h内1～4次心绞痛,29例)和组3(48h内4次以上心绞痛,25例)。统计患者的一般临床情况、院内预后指标(院内死亡、充血性心力衰竭/休克、复合终点等),测量心肌梗死后1周的左室射血分数,肌酸激酶和肌酸激酶同工酶的曲线下面积反映患者的心肌梗死面积。结果:各组的一般临床资料无差别。组2和组3的心肌梗死面积均低于组1(P<0.01),组2和组3间并无差别。组2的复合终点事件发生率低于组1(P=0.03),组3数值低于组1,但差异尚无统计学意义(P=0.05)。左室射血分数和其余院内预后终点各组间无差别。结论:多次梗死前心绞痛并不影响预处理的心肌保护作用。Objective：To investigate the hypothesis that multiple episodes of preinfarction angina pectoris confers the loss of benefit from clinical preconditioning,and provide theoretical evidences for exploring the tolerance timing in clinical preconditioning. Method：We enrolled the patients with acute myocardial infarction who underwent primary percutaneous coronary intervention in the study. The patients were divided into three groups： group 1 （n=55） comprised patients without preinfarction angina;group 2 （n=29） and group 3 （n=25） comprised patients with one to four and more than four episodes of preinfarction angina. Data were collected regarding baseline characteristics,in-hospital outcome （in-hospital death,congestive heart failure/shock,cumulative end-point,et al）. One week left ventricular ejection fraction after episodes of myocardial infarction and myocardial infarct size were determined by total CK and CK-MB units integrated over the first 24 hours. Result：There was no difference in baseline characteristics. The myocardial infaction sizes were lower in group 2 and group 3 than in group 1 （P〈0.01）.However ,there was no difference between group 2 and group 3. The incidence of cumulative end-point in group 2 was lower than group 1 （P=0.03）. Although the quantitative value of cumulative end-point in group 3 was lower than group 1,but it didn＇t reach the statistical significance （P=0.05）. There was no difference in left ventricular ejection fraction and remained in-hospital outcomes. Conclusion：Multiple episodes of preinfartion angina are not associated with the loss of cardioprotection in preconditioning.

关 键 词：心绞痛 梗死前 缺血预处理 心肌 耐受时间窗 

分 类 号：R541.42[医药卫生—心血管疾病]