ST段抬高型心肌梗死溶栓前后心肌缺血修饰白蛋白浓度与心肌再灌注的关系

[目的]观察ST段抬高型心肌梗死（STEMI）患者溶栓前后血管再通和心肌缺血修饰白蛋白（IMA）浓度变化,探讨两者之间的关系及临床意义.[方法]入选STEMI并于发病6 h之内入院患者共80例,均予常规及尿激酶溶栓治疗,根据2 h后有无再灌注表现将患者分成无灌注组（30例）和再灌注组（50例）,两组病人于溶栓前及溶栓后2 h、4 h、6 h分别采血测IMA浓度,并于8、12、14 h采血测肌酸激酶同工酶（CK-MB）浓度.[结果]两组患者溶栓前IMA浓度无明显差异,溶栓后4～6 hIMA浓度有显著差异（P〈0.05）;再灌注组于心肌再灌注恢复后,IMA提前达峰值并回落至正常,IMA达峰值时间较肌酸激酸同工酶（CK-MB）显著提前（P〈0.05）.[结论]STEMI溶栓后心肌是否恢复再灌注与IMA浓度变化存在相关性.IMA早期明显下降可作为STEMI溶栓后心肌恢复有效再灌注的指标.

Relationship Between the Levels of Ischemia-modified Albumin and Myocardial Reperfusion Before and after Thrombolysis in Acute ST-elevation Myocardial Infarction

[Objective]To investigate the changes of ischemia-modified albumin（IMA） levels in ST-elevation myocardial infarction（STEMI） patients before and after thrombolysis, and explore its relationship with myocardial reper fusion. [Methods] Eighty patients with acute STEMI within 6 hours after the onset admitted to our hospital were enrolled in this study. All patients received routine and urokinase thrombolysis. According to whether or not reperfusion, all patients were divided into nonperfusion group and reperfusion group. The blood samples in two groups were collected at 2h, 4h and 6h after thromholysis for detecting the IMA levels. Then the blood samples were collected at 8h, 12h and 14h for detecting creatine kinase isoenzyme（CK-MB） levels. [Results]There was no obvious difference in IMA level before thrombolysis in two groups, but there was significant difference in IMA level after thrombolysis for 4~6 hours. After recovery of myocardial reperfusion, the IMA level in reperfusion group reached the peak value in advance and then returned to the normal, and the peak time of IMA was ahead of that of CK-MB. [Conclusion]There is correlation between the reperfusion and IMA level after STEMI thrombolysis. The obvious decrease of IMA in the early stage can be considered as the effective index of myocardial recovery after STEMIM thrombolysis.