心肌缺血时间对急性心肌梗死患者PCI术后血清sCD40L、sP-sel及心肌重构的影响  

Effects of myocardial ischemia time on serum sCD40L,sP-sel and myocardial remodeling in patients with acute myocardial infarction after PCI

作　　者：韩培天[1] 杜彬彬[1] 张津宁[1] 李文慧[1] Han Peitian;Du Binbin;Zhang Jinning;Li Wenhui(Department of Cardiology, the Second Affiliated Hospital of Hebei North University, Hebei Province,Zhangjiakou 075100, China)

机构地区：[1]河北北方学院附属第二医院心内科,张家口075100

出　　处：《疑难病杂志》2022年第2期114-118,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省张家口市科学技术研究与发展计划项目(1821032D)。

摘　　要：目的探讨心肌缺血时间对急性心肌梗死(AMI)患者PCI术后血清可溶性白细胞分化抗原配体(sCD40L)、可溶性P选择素(sP-sel)及心肌重构的影响。方法选择2018年5月—2020年1月河北北方学院附属第二医院心内科成功行急诊PCI的AMI患者120例,依据患者心肌总缺血时间(TTT)分为早期再灌注组(TTT<6 h,观察组)52例及晚期再灌注组(TTT≥6 h,对照组)68例。比较2组患者治疗前后心肌重构指标、血清sCD40L、sP-sel水平、血管内皮功能、氧化应激、炎性因子水平变化。结果观察组治疗总有效率高于对照组(94.23%vs.67.65%,χ^(2)/P=12.626/0.000)。与治疗前比较,2组患者治疗后血清NO、血管内皮依赖性舒张功能(FMD)、GSH、SOD水平均明显升高,血清sCD40L、sP-sel、IL-6、CRP、TNF-α水平下降,且观察组上述指标改善优于对照组(t/P=7.712/<0.001,3.323/0.001,7.646/<0.001,3.795/<0.001,22.371/<0.001,14.304/<0.001,10.341/<0.001,37.163/<0.001,16.718/<0.001)。治疗后,2组LVEDD及LVESD值均有一定程度降低,LVEF一定程度升高,但差异无统计学意义(P>0.05)。结论经皮冠状动脉介入手术治疗急性心肌梗死患者,早期再灌注较晚期再灌注可更有效降低血清sCD40L、sP-sel水平,减轻炎性反应和氧化应激反应。Objective To investigate the effect of myocardial ischemia time on serum soluble leukocyte differentiation antigen ligand(sCD40L),soluble P-selectin(sP-sel)and myocardial remodeling in patients with acute myocardial infarction(AMI).Methods From May 2018 to January 2020,120 patients with AMI who successfully underwent emergency PCI in the Department of Cardiology of the Second Affiliated Hospital of Hebei Northern University were selected and divided into early reperfusion group(TTT<6 h,Observation group,n=52)and late reperfusion group(TTT≥6 h,control group,n=68).The changes of myocardial remodeling indexes,serum sCD40L,sP-sel levels,vascular endothelial function,oxidative stress and inflammatory factor levels were compared between the two groups before and after treatment.Results The total effective rate of the observation group was higher than that of the control group(94.23%vs.67.65%,χ^(2)/P=12.626/0.000).Compared with before treatment,serum NO,vascular endothelial-dependent diastolic function(FMD),GSH,SOD levels in the two groups were significantly increased after treatment,and serum sCD40L,sP-sel,IL-6,CRP,and TNF-αlevels decreased.The improvement of the above indicators was significantly better than that of the control group(t/P=7.712/<0.001,3.323/0.001,7.646/<0.001,3.795/0.000,22.371/<0.001,14.304/<0.001,10.341/<0.001,37.163/<0.001,16.718/<0.001).After treatment,LVEDD and LVESD values in both groups decreased to a certain extent,and LVEF increased to a certain extent,but the difference was not statistically significant(P>0.05).Conclusion In patients with acute myocardial infarction treated by percutaneous coronary intervention,early reperfusion can more effectively reduce serum sCD40L and sP-sel levels,as well as reduce inflammation and oxidative stress than late reperfusion.

关 键 词：急性心肌梗死 可溶性白细胞分化抗原配体 可溶性P选择素 心肌重构 

分 类 号：R542.22[医药卫生—心血管疾病]