急性ST段抬高心肌梗死患者再灌注心电图变化及其可能的影响因素  

Studies on Electrocardiographic Characteristic and Mechanisms During Myocardial Ischaemia and Reperfusion Injury in Patients with Acute ST Segment Elevation Myocardial Infarction

作　　者：范咏梅[1] 曾晨卉[1] 容志毅[1] 柳素玲[1] 陈友桂[1] 彭玲湘[1] 资新爱[1] 叶冰[1] 

机构地区：[1]湖南省马王堆医院功能科心电图室,湖南省长沙市410016

出　　处：《中国动脉硬化杂志》2010年第6期390-394,共5页Chinese Journal of Arteriosclerosis

基　　金：湖南省科技计划项目(2009FJ3122)资助

摘　　要：目的探讨急性ST段抬高心肌梗死(STEMI)患者缺血再灌注损伤心电图改变及其发生机理。方法分析60例STEMI患者再灌注治疗(溶栓或冠状动脉介入治疗)后缺血再灌注损伤性心电图改变特点及影响因素;根据再灌注治疗后是否发生再灌注损伤性心电图改变而将患者分为再灌注损伤性心电图改变组和再灌注无损伤性心电图改变组;抽静脉血测定活性氧(ROS)、丙二醛(MDA)、还原型谷胱甘肽(GSH)、总抗氧化力(T-AOC)及γ-谷氨酰半胱氨酸合成酶(γ-GCS)活性。结果再灌注心电图心律失常发生率高(65.00%),且以加速性室性自主心律最多见,其次非持续性室速、窦缓和房室传导阻滞;并易出现再灌注损伤性ST段抬高(46.67%)。单因素分析发现冠状动脉血管病变数目、发病至CK达高峰时间、再灌注时间与STEMI患者易发再灌注损伤性心电图改变有关(P<0.05)。溶栓治疗再灌注损伤性心电图改变发生率高于冠状动脉介入治疗(P<0.05)。再灌注心电图改变组血清ROS、MDA显著增高而GSH、T-AOC显著降低;γ-GCS活性高于对照组和缺血组(P<0.05)。结论 STE-MI患者缺血再灌注后再灌注损伤性心律失常与ST段抬高较常见;再灌注复氧后产生氧自由基增多,自由基生成系统/清除系统失衡,可能是发生再灌注损伤性心电图改变重要机制。Aim To investigate the electrocardiographic features and its possible mechanisms at the moment of myocardial ischaemia and reperfusion injury （IRI） in patients with acute ST segment elevation myocardial infarction （STE- MI）. Methods The electrocardiographic changes during reperfusion of acute STEMI by thrombolysis or percutaneous coronary intervention （PCI） were analysed. Effective data of IRI electrocardiographic pattern were explored with univariate analysis. 60 cases of acute STEMI were classified into myocardial reperfusion with IRI electrocardiographic changes group （ reperfusion group A, n = 39） and without IRI electrocardiographic changes group （ reperfusion group B, n = 21 ） . The levels of serum reactive oxygen species （ROS）, malondialdehyde （MDA）, reduced glutathione （GSH）, total antioxidative capacity （T-AOC） and γ-glutamylcysteine synthatase （3,-GCS） activity were measured in control group （n = 43 ）, myocardial ischaemia group （ before reperfusion therapy, n = 60） , reperfusion group A and reperfusion group B. Results Among the 60 cases of acute STEMI, 39 patients （65.00%） with IRI arrhythmia （ accelerated idioventricular rhythm 26.67%, non-paroxysmal ventricular tachyeardia 10.00%, sinus bradycardia 10.00%, and atrioventricular nodol block 8.33% ） as well as 28 patients （46. 67% ） with IRI ST segment elevation were observed. Univariate analysis revealed that the duration from chest pain to receiving reperfusion therapy, the peak time of CK-MB , and reperfusion time were shorter in the reperfusion group B than those in the reperfusion group A （ P 〈 0.05 ）. The more IRI electrocardiographic changes were detected during reperfusion treated by thrombolysis than by PCI （ P 〈 0.05 ）. The levels of serum ROS and MDA in the reperfusion group A were significantly higher, but the GSH and T-AOC were significantly lower than those in the control group, myocardial ischaemia group, and reperfusion group B （ P 〈 0.05 ）. The γ-GCS activi

关 键 词：心肌梗死 心肌再灌注损伤 心电图 氧自由基 Γ-谷氨酰半胱氨酸合成酶 

分 类 号：R5[医药卫生—内科学]