冠心病介入治疗术中冠脉缺血预适应对IMA的影响  

Effect of the Ischemic Preconditioning on Ischemic Modified Albumin During Percutaneous Coronary Intervention

作　　者：陈琳[1,2] 王宁夫[1,2] 叶显华[1,2] 周亮[1,2] 杨建敏[1,2] 童国新[1,2] 沈芸[1,2] 郭士遵[1,2] 来蕾[1,2] 徐鹏[1,2] 

机构地区：[1]杭州市第一人民医院心内科 [2]南京医科大学附属杭州医院,310006

出　　处：《医学研究杂志》2012年第12期85-88,共4页Journal of Medical Research

基　　金：杭州市科技计划项目(20110733Q09)

摘　　要：目的观察冠脉介入治疗术中冠脉缺血预适应对缺血修饰蛋白的影响,探讨缺血修饰蛋白改变对球囊预扩张产生缺血预处理效应的评价意义。方法随机入选60例行冠状动脉造影术的病人,分成行冠脉支架置入手术伴球囊扩张的治疗组(冠脉狭窄程度≥75%)和单纯冠脉造影的对照组(冠脉狭窄程度<75%)。治疗组术中对靶血管的病变行球囊扩张,完全阻断冠脉血流1min,分别测定第1次球囊扩张前5min与扩张后5min及支架置入后5min时的缺血修饰蛋白的水平,对照组测定术前术后的缺血修饰蛋白水平。治疗组所有病人均在连续3次持续1min球囊扩张后再置入支架。结果第1次球囊扩张前5min、球囊扩张后5min、支架置入术后5min时的IMA水平分别为77.09±13.85、90.69±23.34、82.84±21.88U/ml。支架置入术后5min时的IMA水平显著低于第1次球囊扩张后5min时(P=0.026),而支架置入术后5min时的IMA水平与第1次球囊扩张前5min时无显著差异(P=0.150);对照组造影手术前后IMA无明显改变(P=0.70)。结论一过性心肌缺血可以导致IMA水平迅速升高,但反复球囊预扩张或多次发生一过性心肌缺血会诱导缺血预适应反应,可能导致IMA水平回落,甚至恢复至基线水平。Objective To investigate the effect of ischemic preconditioning on ischemic modified albumin（IMA） during percntane- ous coronary intervention,and to investigate the evaluating significance of IMA for the ischemic preconditioning effect attribute to saccule dilations. Methods Totally 60 successive patients who underwent coronary angiography were assigned into two groups： the operation group who underwent PCI with saccule dilations（ the narrowed degree of the vessel ≥ 75% ） and the control group who underwent only angi- ography（ the narrowed degree of the vessel 〈 75% ）. In the operation group, the target vessels underwent saccule dilations, and the blood flow of coronary artery was blocked completely for 1 minute. The levels of IMA 5min before the first saccule dilation,Stain after the first saccule dilation and 5min after stent implanted were measured. In the control group,the levels of IMA before and after angiography were measured. All the patients in the operation group were implanted stent after ad tres vices 1 minute saccule dilations. Results The levels of IMA 5min before the first saccule dilation, 5min after the first saccule dilation and 5min after stent implanted were 77.09 ± 13.85U/ ml,90.69 ± 23.34U/ml and 82.84 ± 21.88U/ml. The IMA level of 5min after stent implanted was significantly lower than that of 5min af- ter the first saccule dilation（ P = 0. 026）. There was no significant difference between the IMA level of 5 min after stent implanted and that of 5min before the first saccule dilation（P = 0. 150）. In the control group the IMA levels before and after angiography had no significant difference （P = 0.70）. Conclusion The IMA level increased fast because of transient myocardial ischemia, but repeated saccule dila- tions or multiple transient myocardial ischemia produced ischemic preconditioning effect which would attenuate the increasing IMA level.

关 键 词：球囊预扩张 缺血预处理 缺血修饰蛋白 

分 类 号：R473.6[医药卫生—护理学]