血清Caspase-3在急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗前后水平变化及其与缺血时间关系  

Changes of serum Caspase-3 levels before and after emergency percutaneous transluminal coronary intervention in patients with acute ST-elevation myocardial infarction and its relationship with ischemia time

作　　者：赵元平 于恺 牛和平[2] 付金国[2] 宋兆伟[1] 穆丽萍[2] 张军[2] ZHAO Yuan-ping;YU Kai;NIU He-ping;FU Jin-guo;SONG Zhao-wei;MU Li-ping;ZHANG Jun(Department of Radiology Intervention;Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院放射介入科,河北沧州061000 [2]沧州市中心医院心内科,河北沧州061000

出　　处：《临床军医杂志》2023年第12期1219-1222,1226,共5页Clinical Journal of Medical Officers

基　　金：河北省医学适用技术(GZ2023055)。

摘　　要：目的探讨血清Caspase-3在急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)前后的水平变化,以及其与PCI后缺血时间的关系。方法选取沧州市中心医院自2018年6月至2021年6月收治的行急诊PCI的124例急性STEMI患者为研究对象。其中,冠状动脉造影显示病变部位在左冠状动脉前降支(LAD)近段35例,LAD中远段20例,右冠状动脉(RCA)近段16例,RCA中远段17例,冠状动脉左旋支(LCX)10例,左冠状动脉第一对角支(D1)或左室后支(PLA)10例,其他16例(左主干、多支病变及未明确病变部位);根据PCI后缺血时间将患者分入4组,分别为0~3 h组(n=20)、3~6 h组(n=58)、6~12 h组(n=40)及12~24 h组(n=6)。所有患者均于术前即刻、术后即刻,以及术后6、12、24、48 h检测Caspase-3酶活力值。分析不同病变部位患者术前Caspase-3酶活力值与缺血时间的相关性,比较不同缺血时间组术前即刻、术后即刻、术后6 h的Caspase-3酶活力值。结果病变部位在LAD近段、RCA近段、LCX、D1或PLA患者的术前Caspase-3酶活力值与缺血时间呈正相关(r分别为0.489、0.542、0.644、0.638,P<0.05);病变部位在LAD中远段、RCA中远段患者的术前Caspase-3酶活力值与缺血时间无明显相关性(r分别为0.410、0.454,P>0.05)。Caspase-3酶活力值在急诊PCI后呈现先升高再下降的趋势,术后6 h的Caspase-3酶活力值在各时间点中最高。0~3 h组、3~6 h组、6~12 h组、12~24 h组术前即刻、术后即刻的Caspase-3酶活力值均随着缺血时间延长而增加;4组术后6 h的Caspase-3酶活力值比较,差异无统计学意义(P>0.05)。0~3 h组、3~6 h组、6~12 h组、12~24 h组术后即刻、术后6 h较术前即刻Caspase-3酶活力值的升高倍数均随着缺血时间延长而减小。结论对于行急诊PCI的急性STEMI患者,病变在LAD近段、RCA近段、LCX、D1或PLA患者的术前Caspase-3酶活力值与缺血时间呈正相关;在缺血时间0~24 h区间内,缺血时间越短,术�Objective To investigate the changes of serum Caspase-3 levels in patients with acute ST-elevation myocardial infarction(STEMI)before and after emergency percutaneous transluminal coronary(PCI),and the relationship between Caspase-3 levels and ischemic time after PCI.Methods A total of 124 patients with acute STEMI who underwent emergency PCI in Cangzhou Central Hospital from June 2018 to June 2021 were selected as the study objects.Among them,coronary angiography showed that the lesions were located in the proximal segment of the left anterior descending coronary artery(LAD)in 35 cases,in the distal segment of the LAD in 20 cases,in the proximal segment of the right coronary artery(RCA)in 16 cases,in the distal segment of the RCA in 17 cases,in the left circumflexal branch of the coronary artery(LCX)in 10 cases,in the first diagonal branch of the left coronary artery(D1)or in the posterior left ventricular branch(PLA)in 10 cases,and in left main trunk,multiple branch lesions and unknown lesion location in 16 cases.According to the ischemic time after PCI,the patients were divided into 4 groups:0-3 hours group(n=20),3-6 hours group(n=58),6-12 hours group(n=40)and 12-24 hours group(n=6).Caspase-3 activity was detected in all patients immediately before surgery,immediately after surgery and 6,12,24,48 hours after surgery.The correlation between preoperative Caspase-3 enzyme activity and ischemia time in patients with different lesion sites was analyzed,and the Caspase-3 enzyme activity values immediately before surgery,immediately after surgery and 6 hours after surgery in different ischemic time groups were compared.Results The preoperative Caspase-3 activity was positively correlated with ischemia time in patients with LAD,RCA,LCX,D1 or PLA(r=0.489,0.542,0.644,0.638,P<0.05).There was no significant correlation between preoperative Caspase-3 activity and ischemia time in patients with distal LAD and distal RCA lesions(r=0.410,0.454,P>0.05).The activity value of Caspase-3 enzyme showed a trend of first increasing a

关 键 词：Caspase-3 急性ST段抬高型心肌梗死 急诊 经皮冠状动脉介入治疗 缺血时间 

分 类 号：R54[医药卫生—心血管疾病]