急诊PCI术后无复流STEMI患者红细胞渗透脆性的变化  

Changes of erythrocyte osmotic fragility in patients with acute ST-segment elevation myocardial infarction and postoperative no-reflow after emergency percutaneous coronary intervention

作　　者：郇雷[1] 刘红岩[1] 亓华新[1] 王方明[1] XUN Lei;LIU Hong-yan;QI Hua-xin;WANG Fang-ming(Department of Cardiology, People's Hospital of Laiwu City, Laiwu 271100, China)

机构地区：[1]莱芜市人民医院心内科,莱芜271100

出　　处：《中国循证心血管医学杂志》2016年第6期712-714,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨急性ST段抬高型心肌梗死（STEMI）患者红细胞渗透脆性的变化与行急诊冠状动脉介入治疗（PCI）术后无复流的关系。方法 选取莱芜市人民医院心血管内科2012年6月~2014年12月急诊PCI治疗的STEMI患者87例，男性55例，女性32例。37例患者PCI术后出现冠状动脉无复流现象（无复流组）、50例患者PCI术后未出现无复流现象（复流组）。所有患者抽取手术前空腹肘静脉血作为检测样品。检测总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）；红细胞渗透脆性最小抵抗值（开始溶血时的氯化钠质量分数，OFmix）、红细胞渗透脆性最大抵抗值（完全溶血时的氯化钠质量分数，OFmax），溶血率分别取：0.45/0.15（第6管/第11管）、0.45/0（第6管/第12管）的比值；红细胞膜Na+-K+-ATP酶活性、丙二醛（MDA）、过氧化物歧化酶（SOD）水平。结果 无复流组的OFmix、OFmax、MCV值显著高于复流组，溶血率（0.45/0.15）、溶血率（0.45/0）也显著高于复流组，差异有统计学意义（P均＜0.01）。无复流组的MDA值显著高于复流组，而红细胞膜Na+-K+-ATP酶活性、SOD水平显著低于复流组，差异有统计学意义（P均＜0.01）。结论 STEMI急诊PCI术后无复流患者较复流患者红细胞渗透脆性显著降低，这可能是导致PCI术后灌注不足的原因之一，而红细胞渗透脆性降低可能与红细胞膜Na+-K+-ATP酶活性、SOD水平降低及MDA水平升高有关。Objective To investigate the relationship between the changes of erythrocyte osmotic fragilityand postoperative no-reflow after emergency percutaneous coronary intervention (PCI) in patients with acute STsegmentelevation myocardial infarction (STEMI). Methods STEMI patients (n=87, male 55 and female 32) werechosen from Jun. 2012 to Dec. 2014, and divided into no-reflow group (n=37) and reflow group (n=50). The fast veinblood was collected as detective samples from all patients before emergency PCI. The levels of total cholesterol (TC),triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C),minimum of erythrocyte osmotic fragility (OFmix) and maximum of erythrocyte osmotic fragility (OFmax), hemolysisratio [0.45/0.15 (6th tube/11th tube), 0.45/0 (6th tube/12th tube)], activity of Na+-K+-ATP, malondialdehyde(MDA) and superoxide dismutase (SOD) were detected. Results OFmix and OFmax were significantly higher, andhemolysis ratio (0.45/0.15) and hemolysis ratio (0.45/0) were also significantly higher in no-reflow group than thosein reflow group (all P<0.01). The level of MDA was significantly higher, and activity of Na+-K+-ATP and SOD weresignificantly lower in no-reflow group than those in reflow group (all P<0.01). Conclusion The erythrocyte osmoticfragility decreases significantly in STEMI patients with postoperative no-reflow after emergency PCI, which maybeone of post-PCI hypoperfusion causes. The decrease of erythrocyte osmotic fragility may be related to the decreasesof activity of Na+-K+-ATP and SOD and increase of MDA level.

关 键 词：急性ST段抬高型心肌梗死 红细胞渗透脆性 急诊冠状动脉介入手术 无复流 

分 类 号：R541.4[医药卫生—心血管疾病]