经皮冠状动脉介入治疗对急性心肌梗死患者左心室重构的影响  

Effect of Percutaneous Coronary Intervention on Left Ventricular Remodeling after Acute Myocardial Infarction

作　　者：刘惠建[1] 丁世芳[2] 

机构地区：[1]南方医科大学研究生学院,广东广州510515 [2]广州军区武汉总医院心血管内科

出　　处：《华南国防医学杂志》2011年第4期326-329,共4页Military Medical Journal of South China

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者行经皮冠状动脉介入(percutaneous coro-nary intervention,PCI)治疗后血清基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)和金属蛋白酶组织抑制因子1(tissue inhibitors of metalloproteinase-1,TIMP-1)水平的变化及其与AMI后近期左心室重构(left ventricular remode-ling,LVRM)和功能的关系。方法选择首次发病AMI患者98例,其中51例(A组)于发病12h之内入院给予直接PCI治疗;22例(B组)于发病12h之后,待病情稳定后行延迟PCI;余25例(C组)给予内科药物保守治疗。同期冠状动脉造影显示无明显局限性狭窄20例为正常对照组(D组)。酶联接免疫吸附剂测定(enzyme-linked immunosorbent as-say,ELISA)法检测血清MMP-9、TIMP-1浓度。二维超声心动图测定舒张末期容积(end diastolic volume,EDV)、收缩末期容积(end systolic volume,ESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVDd)及检查室壁瘤形成情况。结果 A组于PCI术后MMP-9浓度升高,于第7天时MMP-9回落至接近正常对照水平,与B、C组比较有统计学差异(P<0.05)。90天复查EDV、ESV、LVDd及LVEF值A、B组显著优于C组(P<0.05)。发病7天时MMP-9浓度与90天时EDV呈显著正相关(r=0.261,P<0.05),与ESV呈显著正相关(r=0.340,P<0.05),与LVEF呈显著负相关(r=-0.218,P<0.05)。结论 AMI后早期血清MMP-9浓度即升高,LVRM过程中MMP-9浓度与EDV、ESV呈正相关,与LVEF呈负相关,急诊及延迟PCI术能预防心室重构,改善心功能。Objective To investigate the effect of primary percutaneous coronary intervention（PCI） on serum matrix metalloproteinase-9（MMP-9）,tissue inhibitors of metalloproteinase-1（TIMP-1） and left ventricular remodeling（LVRM） after acute myocardial infarction（AMI）.Methods Ninety-eight patients with the first-episode AMI were enrolled.Fifty-one patients（group A） underwent direct PCI within 12 hours after the onset.Twenty-two patients（group B） underwent delayed PCI 12 hours after the onset when their status was stable.The other 25 patients（group C） accepted conservative therapy.Twenty patients without obvious local stenosis examined by coronary angiography were as control group（group D）.Serum MMP-9 and TIMP-1 were measured by enzyme-linked immunosorbent assay（ELISA）.End diastolic volume（EDV）,end systolic volume（ESV）,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVDd） and ventricular aneurysm were evaluated by two dimensional echocardiogram.Results Serum MMP-9 concentration in group A was increased after PCI and decreased near to the normal level at 7 days after the disease onset,which was significantly different from groups B and C（P〈0.05）.The EDV,ESV,LVDd and LVEF levels at 90 days after the disease onset in groups A and B were significantly better than group C（P〈0.05）.The average serum level of MMP-9 at 7 days were positively correlated with EDV（r=0.261,P〈0.05）,ESV（r=0.340,P〈0.05） and negatively correlated with LVEF（r=-0.218,P〈0.05） at 90 days after the disease onset.Conclusion Serum MMP-9 in AMI patients rises early after PCI.During LYRM,the average serum MMP-9 levels are positively correlated with EDV and ESV levels,and negatively correlated with LVEF.Direct PCI and delayed PCI can prevent left ventricular remodeling and improve heart function.

关 键 词：经皮冠状动脉内介入治疗 基质金属蛋白酶9 急性心肌梗死 左心室重构 

分 类 号：R541.4[医药卫生—心血管疾病]