冠状动脉介入治疗对心肌梗死伴不同程度存活心肌患者心功能的影响  

Influences of percutaneous coronary intervention on myocardial activity in myocardial infarction patients with different viable myocardium

作　　者：李丽琪[1] 刘晓红[2] 张锦[2] 来春林[2] 贺业新[3] 

机构地区：[1]山西医学科学院山西大医院全科医学科,太原030032 [2]山西省人民医院心内科 [3]山西省人民医院核磁室

出　　处：《中华内科杂志》2013年第10期811-814,共4页Chinese Journal of Internal Medicine

基　　金：山西省卫生厅科技攻关项目（20100205）

摘　　要：目的 观察冠状动脉介入治疗（PCI）患者梗死心肌质量、左室射血分数（LVEF）和室壁运动异常评分,分析相关因子与左室功能的相关性.方法 选择急性心肌梗死患者43例,利用磁共振延迟成像分为透壁增强组、非透壁增强组和混合组.于PCI术前及术后6个月检测各组患者血清内皮素（ET）、基质金属蛋白酶9（MMP-9）和高敏C反应蛋白（hsCRP）,分析计算各组梗死心肌质量、左室射血分数（LVEF）和室壁运动异常评分.结果 非透壁增强组及混合组患者PCI术后比术前梗死心肌质量[分别为（4.0 ±2.9）g/cm3比（9.8±5.6）g/cm3,（6.0±3.5） g/cm3比（11.8 ±6.2）g/cm3]及LVEF[分别为（52.6±15.4）％比（41.9±16.3）％,（45.6±15.4）％比（38.9±16.3）％]均有改善（P＜0.05）.PCI术前及术后LVEF与梗死心肌质量独立相关（RR分别为0.318及0.293,P＜0.05）,术前LVEF尚与hsCRP水平独立相关（RR为0.318,P＜0.05）.结论 不同心肌梗死程度的患者PCI术后心功能改善情况不同；其改善情况与存活心肌的数量及炎性因子相关.Objective To evaluate the effect of percutaneous coronary intervention （PCI） on left ventricular function in patients with different types of myocardial infarction and to explore the eon＇elation factors for the left ventricular function. Methods A total of 43 patients diagnosed as acute myocardial infarction were enrolled in this study. The perfusion and delayed enhancement magnetic resonance imaging （DE-MRI） was applied to observe the following parameters before the PCI and at month 6 after the procedure ： infarct mass, left ventricular ejection fraction （ LVEF ） and abnormal wall motion score. The subjects were divided into the following three groups by the transmural extent of myocardial infarction manifested in the DE-MRI： the transmural enhancement group, the nontransmural group and the mixed group. Laboratory test was done to detect the level of endothelin （ET） , matrix metal enzyme 9 （ MMP-9 ） and high sensitive C reactive protein （hsCRP） before PCI and at month 6 after the procedure. The t test was used to compare the differences among the groups and the multiple regression analysis was taken to explore the correlation factors for the left ventrieular function. Results Compared with the parameters before PCI, the infarct mass after PCI significantly decreased in the nontransmural group and the mixed group [ （4.0 ＋ 2.9） g/cm3 vs （9.8 ＋5.6） g/era3 and （6.0＋3.5） g/cm3 vs （11.8 ＋6.2）g/cm3, all P〈0.05] , while LVEF was significantly improved after PCI in both groups [ （52. 6 -＋ 15.4） % vs （41.9 -＋ 16.3 ） %, （45.6 ＋- 15.4）% vs （38.9 ＋- 16.3）% , all P 〈0. 05]. The infarct mass was an independent emTelation factor for LVEF before PCI （RR =0. 318 ,P 〈0. 05） and LVEF after PCI（RR =0. 293 ,P 〈0. 05）. LVEF before PCI was independently correlated with the level of hsCRP （RR = 0. 318, P 〈 0. 05 ）. Conclusion The effect of PCI on the improvement of left ventrieular function differs in patients with different extent of myo

关 键 词：心肌梗死 磁共振波谱学 心肌 

分 类 号：R542.22[医药卫生—心血管疾病]