ST段抬高心肌梗死经皮冠状动脉介入治疗后血中肾上腺髓质素研究

目的:探讨ST段抬高心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)后,血液中肾上腺髓质素(AM)2种分子形态在冠状窦-主动脉差值是否有变化。方法:对152例首次发生STEMI患者和53例冠状动脉造影阴性作对照。入选的STEMI患者症状出现后12 h内完成PCI的再灌注治疗。再灌注后取主动脉和冠状窦血,用放免分析的方法测定血浆AM的2种分子形态(AM-m和AM-Gly)。结果:STEMI患者主动脉和冠状窦血浆AM-m、AM-Gly水平明显高于对照组〔(1.8±0.7)比(0.5±0.2)pmol/L,P<0.01〕。STEMI患者血浆AM-m水平的冠状窦-主动脉差值明显高于对照组,而AM-Gly在2组之间无统计学意义(P=0.29)。AM-m的冠状窦-主动脉差值,在伴有左心室(LV)功能障碍的STEMI患者(n=54)明显高于不伴有LV功能障碍的STEMI患者(n=98)。主动脉和冠状窦的血浆AM-m水平与左心室射血分数(LVEF)呈负相关(r=-0.51,r=-0.47,P<0.01)。结论:STEMI再灌注后,尤其伴有严重左心室功能障碍的患者冠状动脉循环血液中有活性的成熟型肾上腺髓质素(AM-m)合成加速。

Plasma levels of two molecular forms of adrenomednllin in corollary circulation after directly percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction

Objective：The purpose of this study was to determine the change of the two molecular forms of adrenomedullin （AM） in coronary sinus and aorta in patients with ST-segment elevated acute myocardial infarction （STEMI） after direct percutaneous coronary intervention（ PCI）. Method： 152 patients with a first episode of STEMI and 53 normal controls were involved. All patients with STEMI underwent PCI reperfusion therapy within 12 h after symptom onset. Plasma levels of two molecular forms of AM （an active, mature form [AM-m] and an intermediate, inactive glycine-extended form [ AM-Gly]） in the aorta and coronary sinus （CS） were measured by specific immunoradiometric assay after reperfusion. Result： Plasma levels of AM-m and AM-Gly in the aorta and CS were higher in STEMI patients than in controls. CS-aorta difference of AM-m, which is an index of myocardial production of AM-m, was significantly greater in STEMI patients than in controls[（1.8 ＋ 0.7） vs. （0.5 ＋ 0.2） pmol/L, P 〈 0.013. However, there was no significant difference between CS and aorta of AM-Gly （ P = 0.29）. STEMI patients with left ventricular dysfunction （ n = 54） had a significantly higher difference in CS-aorta AM-m than STEMI patients without left ventricular dysfunction （ n = 98）. AM-m in the aorta and CS negatively correlated with the left ventricular ejection fraction （r = -0.51, r = -0.47, P 〈 0.01）. Conclusion： Myocardial synthesis of AM-m is increased in patients with reperfused STEMI, especially in patients with critical left ventricular dysfunction.