血清脂蛋白相关磷脂酶A2与心肌梗死后左室重构的实时三维超声心动图研究  

The Relationship between Serum Lipoprotein-associated Phospholipase A2 and Left Ventricular Remodeling After Acute Myocardial Infarction:Real-Time Three-dimensional Echocardiographic Observation

作　　者：邓芸[1] 肖雨雄[1] 陈宝峰[2] 唐良秋[2] 陈锦峰[2] 庞军刚[2] 李小霞 Deng Yun;Xiao Yuxiong;Chen Baofeng;Tang Liangqiu;Chen Jinfeng;Pang Jungang;Li Xiaoxia(Department of Ultrasound,Yuebei People's Hospital,Shaoguan,Guangdong 512026,China;不详)

机构地区：[1]粤北人民医院超声诊断科,广东省韶关市512026 [2]粤北人民医院心血管内科,广东省韶关市512026

出　　处：《中国超声医学杂志》2019年第11期995-998,共4页Chinese Journal of Ultrasound in Medicine

基　　金：韶关市科技计划项目(No.2017CX/K013)

摘　　要：目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)与ST段抬高型心肌梗死(STEMI)患者左室重构的相关性。方法入选185例接受急诊冠脉介入治疗(PPCI)的单纯前壁STEMI患者。术前测定血清Lp-PLA2水平,STEMI 24h内、1周和3个月应用实时三维超声心动图(RT-3DE)测量左室心肌质量指数(LVMI)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)和左室射血分数(LVEF)。入选同期行冠脉造影排除冠心病患者40例为对照组。结果(1)STEMI发病24h内RT-3DE四个指标与对照组比较无显著的差异(P>0.05)。LVEDVI、LVESVI和LVEF均于STEMI 1周恶化达高峰(P<0.01),随后于STEMI 3个月逐渐恢复但仍差于STEMI 24h内(P<0.01)。LVMI于STEMI 1周明显上升(P<0.01),于STEMI 3个月继续上升达高峰(与STEMI 1周比较,P<0.01)。(2)直线相关分析显示:术前Lp-PLA2仅与STEMI 3个月LVMI、LVEDVI和LVESVI均呈正相关,与STEMI 3个月LVEF呈负相关(P<0.05)。多因素分析排除其他因素的干扰后,术前Lp-PLA2仅与STEMI 3个月LVMI存在正相关(β=0.523,P<0.05)。结论血清Lp-PLA2对单纯前壁STEMI后左室重构具有重要意义,术前检测可预测此类患者PPCI后早期左室重构程度。Objective To investigate the relationship between serum lipoprotein-associated phospholipase A2(Lp-PLA2)and left ventricular remodeling 3 months after first anterior ST-elevation myocardial infarction(STEMI)in patients managed by primary percutaneous coronary intervention(PPCI).Methods A total of 185 admitted patients with first STEMI of the anterior wall undergoing PPCI were enrolled.Serum Lp-PLA2 was evaluated before PPCI.Left ventricular end-diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI),left ventricular myocardial mass index(LVMI)and left ventricular ejection fraction(LVEF)were measured by application of realtime 3 Dechocardiography within 24 hours,1 week and 3 months of STEMI.Forty patients excluded from coronary heart disease were selected as control group.Results LVMI,LVEDVI,LVESVI and LVEF did not significantly deteriorate within 24 hours of STEMI(P>0.05).LVEDVI,LVESVI and LVEF all markedly worsened at 1 week of STEMI(P<0.01),then gradually recovered at 3 months of STEMI,but did not reach the levels of 24 hours(P<0.01).LVMI continued to rise significantly at 1 week of STEMI(P<0.01),and reached its peak at 3 months of STEMI(compared with that at 1 week of STEMI,P<0.01).Preoperative Lp-PLA2 was positively correlated with LVMI,LVEDVI and LVESVI and negatively correlated with LVEF at 3 months of STEMI(all P<0.05).However,only the relationship between preoperative Lp-PLA2 and LVMI at 3 months of STEMI persisted in multiple stepwise linear regression model(β=0.523,P<0.05).Conclusions Lp-PLA2 plays an important role in left ventricular remodeling after anterior STEMI in patients undergoing PPCI.Preoperative serum Lp-PLA2 may predict the early left ventricular remodeling in these patients.

关 键 词：脂蛋白相关磷脂酶A2 ST段抬高型心肌梗死 实时三维超声心动图 左室重构 

分 类 号：R54[医药卫生—心血管疾病]