肾素-血管紧张素-醛固酮系统与急性心肌梗死短期预后关系的研究

目的研究肾素-血管紧张素-醛固酮系统(RAAS)与急性心肌梗死短期预后的相关性。方法纳入2012年6月~2012年12月江西省人民医院急性心肌梗死患者33例(AMI组)及健康体检者30例(对照组),比较两组RAAS系统中血清肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)的水平差异。3个月后对AMI组患者行彩色超声心动图测定左室功能[包括:左室舒张末径(LVEDD)、左室收缩末径(LEVSD)和射血分数(LVEF)],观察其与RAAS的相关性;同时按照AngⅡ水平将AMI组分为低AngⅡ亚组(AngⅡ≤249.1 pg/ml,n=19)和高AngⅡ亚组(AngⅡ249.1 pg/ml,n=14),观察3个月随访期间两组心血管事件(MACE)的发生情况。结果与健康组相比,AMI组患者PRA[(6.5±2.4)ng/(ml.h)vs.(0.5±0.4)ng/(ml.h)]、AngⅡ[(226.9±66.3)pg/ml vs.(47.4±11.9)pg/ml]、Ald[(401.8±91.2)vs.(294.1±43.4)pg/ml]水平均较高,差异有统计学意义(P0.01);AMI组患者AngⅡ水平与患者3个月后的LVEDD(r=0.788,P0.01)及LEVSD呈正相关(r=0.770,P0.01),与LVEF呈负相关(r=-0.782,P0.01);AMI患者中高AngⅡ亚组3个月内心血管事件发生率显著高于低AngⅡ亚组(100%vs.42.11%,P0.01)。结论心肌梗死患者存在RAAS过度激活,AngⅡ水平与心肌梗死后左室重构、心功能及心血管事件等预后情况明显相关。

Renin-angiotensin-aldosterone system and prognosis of acute myocardial infarction

Objective To study the correlation between renin-angiotensin-aldosterone system （RAAS） and short-term prognosis of acute myocardial infarction （AMI）. Methods The patients （n=33, AMI group） and health persons （n=30, control group） were chosen from the People’s Hospital of Jiangxi Province from Jun. 2012 to Dec. 2012. The levels of plasma rennin activity （PRA）, angiotensinⅡ（AngⅡ） and aldosterone （Ald） were compared between two groups. After 3 months, the left ventricular function （including LVEDD, LEVSD and LVEF） was detected by using color Doppler and the correlation between these indexes and RAAS was observed. AMI group was further divided into low AngⅡgroup （AngⅡ≤249.1 pg/mL, n=19） and high AngⅡgroup （AngⅡ＆gt;249.1 pg/mL, n=14） and the incidence of major adverse cardiovascular events （MACE） was observed during 3-month follow-up period. Results Compared with control group, the levels of PRA [（6.5±2.4） ng/（mL.h） vs. （0.5±0.4） ng/（mL.h）], AngⅡ[（226.9±66.3） pg/mL vs. （47.4±11.9） pg/mL] and Ald [（401.8±91.2） vs. （294.1±43.4） pg/mL] were higher in AMI group （P〈0.01）. The level of AngⅡwas positively correlated to levels of LVEDD （r=0.788, P〈0.01） and LEVSD （r=0.770, P〈0.01）, and negatively correlated to level of LVEF （r=-0.782, P〈0.01） in two AngⅡgroups. The incidence of MACE was significantly higher in high AngⅡgroup than that in low AngⅡgroup （100%vs. 42.11%, P〈0.01） within 3 months. Conclusion An excessive activation of RAAS can be observed in AMI patients, and level of AngⅡis positively correlated to left ventricular remodeling, heart function and MACE after AMI.