血运重建对急性心肌梗死患者心脏胶原重构及左心功能的影响

目的评价血运重建对急性心肌梗死(AMI)患者心脏胶原重构及左心室收缩、舒张功能的影响。方法将54例AMI患者依是否接受血运重建治疗分为常规药物治疗组(n=18)和血运重建组(n=36),应用酶联免疫法检测AMI后3、6及12个月的血清Ⅰ型前胶原羧基端肽(PICP)和Ⅲ型前胶原(PCⅢ),同时行心脏彩色超声检测左室射血分数(LVEF)、二尖瓣血流舒张早期流速(E)和心房收缩期流速(A)比值(E/A)、二尖瓣环收缩期运动速度峰值(Sa)、舒张早期运动速度峰值(Ea)和舒张晚期运动速度峰值(Aa),并计算Ea/Aa比值。以20例健康体检者为对照组进行对比分析。结果血运重建组PICP在3、6个月时点,PCⅢ在3月时点明显低于同期常规治疗组(P<0.01);血运重建组LVEF在6个月、12个月时点和Sa在6个月时点明显大于同期常规治疗组(P<0.01);血运重建组各时点E/A、Ea/Aa较同期常规治疗组差异无统计学意义(P>0.05)。结论实施血运重建可以明显抑制心脏胶原重构,改善心肌收缩功能,而对舒张功能的改善不明显。

Effect of revascularization on left ventricular collagen remodeling and function in patients with acute myocardial infarction

Objective To evaluate the effect of revascularization on left ventricular collagen remodeling and function in patients with acute myocardial infarction（AMI） by euzyme-linked immunosorbent assay（ELISA）,two dimensional echocardiography and Doppler Tissue Imaging（DTI）.Methods According to the different therapies,54 patients with AMI were divided into 2 groups：routine medical treatment group（18 patients） and revascularization group（including intravenous thrombolysis,primary percutaneous coronary intervention and delay percutaneous coronary intervention,36 patients）.The serum of concentration of PICP、PCⅢwere measured by ELISA on the 3th months,the 6th months,the 12th months after AMI;The left ventricle ejection fraction（LVEF）,ratio of early diastolic blood flow velocity of mitral valve（E） and blood flow velocity of atrium systolic period（A） were measured by two dimensional echocardiography in patients with all testee.And mitral annulus velocities from posteroseptal,lateral, anteroseptal,posterior,anterior and inferior segments during systole（Sa）,early diastole（Ea） and atrial contraction （Aa） were measured by DTI,Sa,Ea,Aa were calculated from average of above 6 segments separately.and then Ea/ Aa was calculaterd.20 healthy people of medical examination are considered control group.Results On 3th month, PCⅢof revascularization group was reduced in the comparison with drug trentment group（P0.01）.On 3th month and 6th month,PICP of revascularization group was reduced in the comparison with drug trentment group（P0.01）;LVEF on 6th months,12th months and Sa on 6th months of revascularization group were increased compared to LVEF and Sa on the same time of drug trentment group;E/A and Ea/Aa of revascularization group have no evident diffence to drug trentment group on every monment（P0.05）.Conclusion The revascularization after AMI can efficiently depress cardiac collagen remodeling,improve left ventricular systolic function and failed to improve diastolic function;DTI can reflect the changs of left ventricular function sensitively and exactly.