老年陈旧性心肌梗死患者组织纤维化血清指标的观察

目的　通过对老年陈旧性心肌梗死 (MI)患者组织纤维化血清指标变化的观察 ,探讨将其作为反映MI患者心肌纤维化过程指标的临床应用价值。方法　测定MI患者 38例 ,心绞痛 (AP)患者 32例及健康老年人 (对照组 ) 34名的血清Ⅰ型前胶原 (PCⅠ )、Ⅲ型前胶原 (PCⅢ )、层粘连蛋白 (LN)和透明质酸 (HA)水平。结果　 (1)MI组的血清PCⅠ、PCⅢ、LN和HA水平较AP组和对照组显著升高 ;(2 )血清中PCⅠ、PCⅢ、LN和HA各值之间呈正相关 ;(3)MI组中的 2个以上部位的MI较单个部位MI的血清PCⅠ、PCⅢ和LN水平显著升高 ;(4 )多因素分析显示 ,MI组中PCⅠ、PCⅢ、LN、HA与左室舒张末期内径、MI部位及病程、<40 %左心室射血分数 (EF)值相关。结论　血清PCⅠ、PCⅢ和LN和HA均可作为MI患者心脏组织纤维化过程的监测指标 ,可为临床评估MI累及的范围、预后、心功能及了解MI的纤维化过程提供间接依据。

Observation on serum indexes of tissue fibrosis in aged patients with previous myocardial infarction

Objective To study the changes of tissue fibrosis indexes in serum and to evaluate their clinical value in reflecting the process of fibrosis in aged patients with previous myocardial infarction (MI).Methods Procollagen type I (PCⅠ),procollagen type Ⅲ(PCⅢ),laminin(LN) and hyaluronic acid (HA) in serum were measured in 38 cases of myocardial infarction(MI group),32 cases of angina pectoris (AP group) and 34 normal aged people (NS group).Results (1) PCⅠ、PCⅢ、LN and HA levels of serum in MI group were significantly higher than those in AP group and NS group (P<0.05 or P< 0.01).(2)PCⅠ、PCⅢ、LN and HA in serum positively correlated with each other (r=0.19-0.55).(3) PCⅠ、PCⅢ、LN in patients with MI over 2 sites were significantly higher than those in patients with MI of 1 site(P<0.01).(4) Multifactor analysis showed that PCⅠ、PCⅢ、LN and HA correlated with end diastolic internal diameter of left ventricle,MI site,disease,course and <40% ejection fraction (EF) of left ventricle in MI group.Conclusions PCⅠ、PCⅢ,LN and HA in serum can be the diagnosis indexes of myocardial fibrosis in MI patients and provide the indirect basis for clinical evaluation of the area,prognosis,course of fibrosis and heart function in MI.