探讨再灌注时间与心律失常发生率关系以及氧化应激、炎症反应变化趋势  

Investigate the correlation between reperfusion time and incidence of arrhythmia and trend of oxidative stress and inflammatory response

作　　者：王健兵[1] 阴丽 万艳 马艳艳[3] 刘颖 盛艳玲[4] Wang Jian-bing;Yin Li;Wan Yan;Ma Yan-yan;Liu Ying;Sheng Yan-ling(Department of Cardiology,General Hospital of Huabei Petroleum Administration Bureau,Renqiu 062552,Hebei,China;Department of General Practice,General Hospital of Huabei Petroleum Administration Bureau,Renqiu 062552,Hebei,China;Department of Geriatrics,General Hospital of Huabei Petroleum Administration Bureau,Renqiu 062552,Hebei,China;Department of Respiratory,General Hospital of Huabei Petroleum Administration Bureau,Renqiu 062552,Hebei,China;Department of Cardiology,Traditional Chinese Medicine Hospital of General Hospital of Huabei Petroleum A dministration Bureau,Renqiu 062552,Hebei,China)

机构地区：[1]华北石油管理局总医院心血管内科,河北任丘062552 [2]华北石油管理局总医院全科医学科,河北任丘062552 [3]华北石油管理局总医院老年病科,河北任丘062552 [4]华北石油管理局总医院呼吸内科,河北任丘062552 [5]华北石油管理局总医院中医医院内科,河北任丘062552

出　　处：《兰州大学学报（医学版）》2021年第6期68-73,共6页Journal of Lanzhou University（Medical Sciences）

基　　金：河北省2015年度医学科学研究重点课题计划资助项目(20150822)。

摘　　要：目的观察急性ST段抬高心肌梗死(STEMI)患者不同血管再通时间、再灌注治疗与再灌注心律失常(RA)发生率的关系及血清过氧化物歧化酶(SOD)、丙二醛(MDA)、高敏C-反应蛋白(hs-CRP)、心肌肌钙蛋白I (cTnI)的变化趋势。方法选取成功行急诊冠状动脉支架置入术(PCI)或静脉溶栓再通的464例STEMI患者,根据再灌注治疗距发病时间分为3组:≤3 h组、>3~6 h组和>6~12 h组。观察再灌注治疗后3 h内RA的发生率、测定再灌注治疗前和治疗后血清SOD,MDA浓度、hs-CRP,cTnI质量浓度。结果再灌注时间≤3 h患者RA发生率(87.4%)较> 3~6 h组(47.9%)和>6~12 h组(21.3%)明显升高(P<0.01),其中PCI者(89.7%)较静脉溶栓者(75.3%)更高(P<0.05);静脉溶栓发生RA者再灌注治疗后MDA浓度、hs-CRP,cTnI质量浓度较非RA者明显升高(P<0.05),SOD质量浓度较非RA者明显降低(P<0.05),PCI术发生RA者再灌注治疗后MDA浓度、hs-CRP,cTnI质量浓度较非RA者明显升高(P<0.05),SOD浓度较非RA者明显降低,2种再灌注治疗有相同趋势。结论再灌注时间≤3 h的STEMI患者RA发生率较高,尤其是再灌注方式采用PCI者,临床应加强防范心律失常。RA的发生与氧化应激和炎症反应相关。Objective To observe the incidence of reperfusion arrhythmia(RA) in different reperfusion time of patients with acute ST-segment elevation myocardial infarction(STEMI) after reperfusion treatment and the trend of superoxide dismutase(SOD), malondialdehyde(MDA), and high-sensitivity C-reactive protein(hs-CRP) and cardiac troponin I(cTnI). Method A total of 464 STEMI patients who successfully underwent percutaneous transluminal coronary intervention(PCI) or intravenous thrombolysis and recanalization were selected. According to the time between reperfusion treatment and onset, the patients were divided into 3 groups: ≤ 3 h group, > 3 ~ 6 h group and > 6 ~ 12 h group. The incidence rate of RA was observed after reperfusion treatment within 3 hours. Meanwhile, Serum concentrations of SOD, MDA, hs-CRP and cTnI were measured before and after reperfusion treatment. Result The incidence of RA was highest in those of reperfusion treatment ≤ 3 hours from onset(84.7%), which was significantly increase than those of reperfusion treatment> 3~6 hours(47.9%) and > 6~12 hours from onset(21.3%)(P < 0.01), and the incidence of RA was higher in PCI patients(89.7%) than in intravenous thrombolysis patients(75.3%)(P < 0.05). The levels of MDA, hsCRP and cTnI in patients with RA significantly increased than those without RA in patients of intravenous thrombolysis(P < 0.05), while the levels of SOD decreased significantly(P < 0.05). The levels of MDA,hs-CRP and cTnI in patients with RA significantly increased than those without RA in patients of PCI(P < 0.05), while the levels of SOD decreased significantly(P < 0.05). The two reperfusion treatments had the same trend. Conclusion When reperfusion time was less than 3 hours, the incidence of RA was higher,especially in reperfusion mode of PCI. Therefore, clinical prevention of arrhythmia should be strengthened. The occurrence of RA is related to oxidative stress and flammatory response.

关 键 词：再灌注心律失常 再灌注时间 ST段抬高心肌梗死 过氧化物歧化酶 心肌肌钙蛋白I 

分 类 号：R542.22[医药卫生—心血管疾病]