心肌细胞凋亡在老年性缺血再灌注后心力衰竭发生中的作用  

Role of myocardial apoptosis in elderly patients with heart failure following ischemia/reperfusion

作　　者：张武宁[1] 陈牧雷[2] 杨新春[2] 范谦[2] 

机构地区：[1]北京市房山区第一医院心内科,102400 [2]首都医科大学附属北京朝阳医院心脏中心

出　　处：《中华老年心脑血管病杂志》2013年第8期795-798,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(30800448)

摘　　要：目的探讨年龄对急性心肌梗死(AMI)患者心肌细胞凋亡以及心功能的影响。方法选择2010年10月～2012年12月在我院心内科住院的急性心肌梗死(AMI)患者65例,分为年龄<65岁组(AMI 1组)29例,年龄≥65岁组(AMI 2组)36例。另选健康志愿者45例,分为年龄<65岁组(志愿1组)24例,年龄≥65岁组(志愿2组)21例。AMI 1组和AMI 2组患者均在发病6h内接受急诊PCI,并于术后1、3和5d检测可溶性脂肪合成酶(sFas)、白细胞介素(IL)6、TNF-α和心肌肌钙蛋白I(cTnI)水平。在入院即刻及第5天进行超声多普勒检查并采用Killip分级评价心功能。结果与志愿1组、AMI 1组比较,志愿2组、AMI 2组LVEF、左心室缩短分数(LVFS)、二尖瓣舒张早期血流峰值(E)/二尖瓣舒张晚期血流峰值(A)比值明显降低(P<0.01);与AMI 1组比较,AMI 2组Killip分级、sFas、IL-6、TNF-α及PCI术后1、3和5dcTnI水平均明显升高(P<0.01)。结论老龄化加剧了心肌缺血再灌注后心肌的损伤,心肌细胞凋亡水平的差异在其中可能起到了关键的作用。Objective To study the effect of age on myocardial apoptosis and cardiac function in pa- tients with acute myocardial infarction（AMI）. Methods Sixty-five AMI patients admitted to our department from October 2010 to December 2012 were divided into 〈65 years old group （AMI group 1,n=29） and ≥65 years old group （AMI group 2,n=36）. Forty-five healthy volunteers were divided into （65 years old group （volunteer group 1 ,n=24） and ≥65 years old group （volunteer group 2,n=21）. Patients in AMI group 1 and AMI group 2 underwent percutaneous coronary intervention （PCI） in emergency department 6 h after onset of AMI,and their serum levels of soluble fatty sybthetase （sFas）,IL-6,TNF-α, cardiac specific troponin I （cTnI） were measured 24 h,3 and 5 days after PCI. Their cardiac function was assessed by Doppler ultrasonography and Killip class immediately and 5 days after admission. Results The LVEF,LVFS,and the peak value of early/advanced mitral valve diastole were significantly lower in AMI group 1 and volunteer group 1 than in AMI group 2 and volunteer group 2 （P〈0.01）. The Killip class and serum levels of sFas,IL-6 ,TNF-α,cTnI were significantly higher in AMI group 2 than in AMI group 1 24 h,3 and 5 days after PCI （P〈0.01）. Conclusion Aging exacerbates myocardial injury following is- chemia/reperfusion due to the key role of differential myocardial apoptosis.

关 键 词：心肌梗死 肌细胞 心脏 细胞凋亡 心力衰竭 心肌再灌注损伤 白细胞介素6 肿瘤坏死因子α 

分 类 号：R541.6[医药卫生—心血管疾病]