血管性血友病因子和ADAMTS-13水平与急诊冠状动脉支架置入术后冠状动脉血流的关系  

Relationship between post-stenting coronary thrombolysis in myocardial infarction flow and plasma von Willebrand factor and ADAMTS-13 levels in patients with ST segnent elevation myocardialinfarction

作　　者：周青[1] 李剑[1] 罗心平[1] 施海明[1] 陈华[1] 赵碧莲[1] 朱军[1] 倪唤春[1] 沈伟[1] 王彩萍[1] 

机构地区：[1]复旦大学附属华山医院心内科,上海200040

出　　处：《中华心血管病杂志》2011年第3期212-216,共5页Chinese Journal of Cardiology

基　　金：复日大学附属华山医院院级基金（2008-126）

摘　　要：目的探讨急性sT段抬高型心肌梗死（STEMI）患者血浆血管性血友病因子（vWF）和其裂解酶ADAMTS．13水平与急诊冠状动脉支架置入术后冠状动脉心肌梗死溶栓试验（TIMI）血流的关系。方法根据支架释放后即刻造影显示的TIMI血流情况，将2007年9月至2009年12月期间在我院行急诊冠状动脉支架置人术的STEMI患者分为TIMI≤2级组（最终入选43例）和TIMI3级组（最终入选43例），并选择同期冠状动脉造影正常的胸闷、胸痛患者作为阴性对照组（43例）。采用双抗体夹心酶联免疫吸附法（ELISA）分别在入院即刻、冠状动脉介入术开始即刻以及介入术后1周检测患者外周血vwF和ADAMTS-13水平。结果在不同时间TIMI≤2级组和TIMI3级组血浆vWF水平均显著高于阴性对照组（均P〈0．05）。TIMI≤2级组血浆vWF水平在不同时间均显著高于TIMI3级组[分别为人院即刻（6721．83±1380．58）U／L比（4786．12±2362．01）U／L，P〈0．05；介入术开始即刻（5744．65±1240．71）U／L比（3011．33±2270．40）U／L，P〈0．05；介入术后1周（2001．48±931．70）U／L比（1365．17-4±724．12）U／L，P〈0．05]。3组患者入院即刻和介入术开始即刻血浆ADAMTS．13水平差异无统计学意义。术后1周TIMI≤2级组ADAMTS-13水平明显高于TIMI3级组[（406．93±101．44）mg／L比（270．34±115．12）mg／L，P〈0．05]。logistic回归分析表明，入院即刻vwF水平（OR：1．917，P〈0．01）和介入术开始即刻vWF水平（OR：2．016，P〈0．01）均是影响支架术后冠状动脉TIMI血流的危险因素。结论STEMI患者急诊支架术后冠状动脉TIMI血流状况与患者术前血浆vwF水平有关，vWF与ADAMTS-13的失衡可能是急诊支架置入术后冠状动脉血流缓慢的原因之一。Objective To investigate the relationship between post-stenting coronary thrombolysis in myocardial infarction （TIMI） flow and plasma yon Willebrand factor （vWF） and its cleaving protease （ADAMTS-13） levels in patients with ST segment elevation myocardial infarction （STEMI）. Methods STEMI patients who underwent primary percutaneous coronary intervention （ PCI ） and stenting between September, 2007 and December, 2009 were enrolled. According to the post-stenting TIMI flow, patients were divided to TIMI ≤2 group （n =43 ） and TIMI 3 group （n = 43 ）. Patients with chest pain or dyspnea and normal coronary angiographic results served as control group （ n = 43 ） . The levels of vWF and ADAMTS-13 were measured by ELISA at three time points： immediatly after admission, beginning of PCI and 1 week after PCI. Results Levels of vWF in STEMI patients at all 3 time points were significantly higher than in control patients, and the level of vWF was significantly higher in TIMId≤2 group than in TIMI3 group [at admission： （6721.83 ± 1380.58）U/L vs. （4786. 12 ±2362.01） U/L, P 〈0.05; at the beginning of PCI： （5744. 65± 1240. 71） U/L vs. （3011.33 ±2270.40） U/L, P 〈0. 05 and at 1 week after PCI： （200l. 48 ±931.70） U/L vs. （ 1365.17 ± 724. 12 ） U/L, P 〈 0.05 ] . ADAMTS-13 levels were similar among groups at admission and at beginning of PCI, however, the level of ADAMTS-13 at 1 week after PCI was significantly higher in TIMId〈2 group than that in TIMI 3 group [（406. 93± 101.44 ）mg/L vs. （ 270. 34 ± 115.12） mg/L, P 〈 0. 13011. Logistic regression analysis showed that both vWF at admission （ OR = 1. 917, P 〈0.01 ） and vWF at the beginning of PCI （ OR = 2. 016, P 〈 0.01 ） were risk factors of TIMId〈2. Conclusion Increased vWF during peri-PCI periods was associated with post-stenting coronary TIMI ≤2 after primary PCI in STEMI patients, and the imbalance between vWF and ADAMTS-13 may thus play an important role in the development

关 键 词：血管成形术 经腔 经皮冠状动脉 von WILLEBRAND因子 心肌再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]