缺血预适应对急性心肌梗死近期预后的影响

目的观察梗死前心绞痛对急性心肌梗死(AMI)近期预后的影响。方法对123例首次发生AMI的住院患者,根据其梗死 前48h内有无心绞痛发作,分为有心绞痛组(IP组,64例)及无心绞痛组(NIP组.59例),比较两组心肌酶(CPK)峰值、心肌梗死 范围及心脏事件发生率。结果IP组较NIP组心肌酶峰值低,心肌梗死范围小(P<0.01),心脏事件发生率低(P<0.05)。结论 急性心肌梗死前48h内发作的心绞痛可能由于缺血预适应而对心肌具有保护作用。     

梗死前心绞痛持续时间对梗死心肌保护作用的影响

目的:探讨梗死前心绞痛持续时间的长短对初次急性心肌梗死患者临床状况及近期预后的影响。方法:选择我院317例初发心梗的住院病人,按梗死前48小时内有无心绞痛发作及每次持续时间的长短分为三组。Ⅰ组:梗死前心绞痛持续时间<15分钟;Ⅱ组:梗死前心绞痛持续时间>15分钟;Ⅲ组(对照组):梗死前48小时内无心绞痛发作。通过测定梗死后肌酸激酶(CK)峰值和左室射血分数(LVEF),比较梗死范围及心功能情况,并对住院期间各组心脏事件的发生率及死亡率进行比较分析。结果:Ⅰ组病例的临床状况及近期预后明显优于其他两组。表现为:梗死范围的缩小,严重心律失常、心源性休克、死亡的发生率明显降低,差异具有显著统计学意义(P<0.01)。但Ⅱ、Ⅲ组间各观察数据无统计学差异(P>0.05)。结论:梗死前心绞痛持续时间不同对心肌梗死患者近期预后可能产生不同影响,梗死前近期有短时间(<15分钟)的缺血刺激对梗死心肌具缺血预适应的保护作用。     

心肌缺血预适应对急性心肌梗死病人的影响

目的 对首次急性心肌梗死（AMI）发生前24h、24h～48h、〉48h有无发作过心绞痛的病人的临床状况及近期预后进行评价。方法 158例AMI病人分为两组，缺血预适应组（观察组）46例，其中24h内发生心绞痛ll例，24h～48h内发生心绞痛6例，〉48h发生心绞痛29例；非心肌缺血预适应组（对照组）112侧。结果 观察组除〉48h外，均比对照组心肌梗死范围小（P〈0，01），血浆肌酸磷酸激酶（CPK）、乳酸脱氢酶（LDH）、谷草转氨酶（AST）峰值低（P〈0．01），住院期间发生心功能不全、心源性休克、死亡等心脏事件发生率明显降低（P〈0．05）。结论 首次急性心肌梗死前48h以内发作的心绞痛对AMI心肌具有明显的保护作用，其机制可能与心肌缺血预适应有关。     

心肌缺血预适应对急性心肌梗死影响的观察

目的:探讨心肌缺血预适应对急性心肌梗死(AMI)临床表现及其预后的影响。方法:根据AMI前有无心绞痛发作分为预缺血组和无预缺血组,分组观察AMI患者血清肌酸磷酸激酶(CPK)峰值,住院期间并发症(心衰、心源性休克、严重心律失常),以及住院期间心性病死率。结果:预缺血组血清CPK峰值明显低于无预缺血组(P<0.05),住院期间心源性休克及严重心律失常发生率明显低于无预缺血组(P<0.05)。结论:心肌缺血预适应可减轻心肌坏死程度,缩小梗死面积,并减少AMI并发症的产生。     

心肌缺血预适应对急性心肌梗死后并发症的影响

目的探讨心肌缺血预适应对急性心肌梗死(AM I)临床预后的近期影响。方法分析76例AM I患者的临床资料,根据患者AM I前24h内有无明确的心绞痛(AP)发作将患者分为两组,并对其临床资料及其住院后并发症的发生情况进行回顾性分析。结果有心绞痛组血清酶(CK、CK-MB)的峰值明显小于无心绞痛组,有心绞痛组发生AM I时梗死的面积明显小于无心绞痛组,心力衰竭(CHF)、心源性休克、住院期间病死率与无心绞痛组相比差异有非常显著性意义(P<0.01),两组Q-Td的变化与心律失常的发生情况相比则无明显差异(P>0.05)。结论心肌缺血预适应具保护心肌细胞、促进侧支循环建立、减轻心肌缺血、缩小心肌梗死范围、减轻心肌梗死后心功能不全和降低住院期间病死率的作用,进而改善AM I患者的近期预后。     

心肌缺血预适应对老年心肌梗死范围和预后的影响

目的研究缺血预适应对老年心肌梗死范围和预后的影响。方法将120例首次老年心肌梗死患者依据梗死前有无心绞痛发作分为缺血预适应组(74例)和非缺血预适应组(46例),通过心电图计分法和磷酸肌酸激酶峰值水平比较最初心肌梗死面积;并统计两组出现并发症和住院期间病死率。结果心肌梗死中确存在缺血预适应,缺血预适应组在最初心肌梗死面积和严重并发症(心源性休克、急性肺水肿和恶性心律失常等)均少于非缺血预适应组(P<0.05)。结论心肌梗死前的心肌缺血预适应对老年心肌梗死患者的心肌有一定的保护作用。     

心肌缺血预适应对初发急性心肌梗死病人临床及预后的影响

目的探讨心肌缺血预适应对初发急性心肌梗死（AMI）病人梗死范围及近期预后的影响。方法对116例初发AMI骗人．按梗死前48h有无心绞痛分为缺血预适应组（IPC，64例）、无缺血预适应组（NIPC，52例），对比分析两组病人的临床资料。结果IPC组比NIPC组的心肌梗死范围小（P〈0．05），血清心肌酶学峰值低（P〈0．05），恶性心律失常、心力衰竭、心源性休克、室壁瘤发生率及病死率均明显降低（P〈0．05）。结论心肌缺血预适应具有保护心肌、缩小梗死范围。改善近期预后的作用。     

缺血预适应对急性心肌梗死Q—T离散度及室性心律失常的影响

目的探讨缺血预适应对急性心肌梗死Q-T间期离散度及室性心律失常的影响.方法根据318例首次急性心肌梗死患者发病前48h内是否发生心绞痛,分为缺血预适应组(186例)和无缺血预适应组(132例),另取健康人11l例作为对照组,测定每例校正Q-T间期离散度(Q-Tcd).结果无缺血预适应组Q-Tcd(70.47±12.05ms)明显大于缺血预适应组(55.96±10.4lms,P＜0.01),缺血预适应组明显大于对照组(42.47±9.17ms,P＜0.01).缺血预适应组室性心动过速、心室颤动及猝死的发生率明显低于无缺血预适应组(P均＜0.01).结论缺血预适应可明显减小急性心肌梗死时的Q-T离散度,降低室性心律失常和猝死的发生率.     

长期心肌缺血对急性心肌梗塞预后的影响

目的:探讨长期心肌缺血对急性心肌梗塞(AMI)临床表现与近期预后的影响.方法: 回顾性分析了596例心绞痛(AP)病程≥2周的AMI的临床资料,并与无AP史或AP<2周的患者比较.结果: AP组合并休克、心衰者少于对照组(分别为10.9% 比15.8%和19.8% 比25.0%,均P<0.05),住院病死率也较低(11.4% 比15.7%,P<0.05),AP组梗塞前正规治疗者多于对照组(58.4%比29.1%,P<0.001),患高血压者也较多(53.1% 比41.2%,P<0.001),但大面积梗塞较少,肌酸激酶峰值较低.结论: 长期心肌缺血可能也有缺血预适应作用,有益于AMI的近期预后.     

心肌缺血预适应对急性心肌梗塞面积及近期预后的影响

目的　观察急性心肌梗塞心绞痛发作 ,与梗塞范围及近期预后的关系。方法　 2 1 9例急性心肌梗塞患者分为梗塞前 72小时有心绞痛组 ( A组 ) 93例 ,无心绞痛组 ( B组 ) 1 2 6例。对两组的梗塞面积 ,并发症和病死率进行比较分析。结果　有心绞痛组的心肌梗塞范围小 (两组间有显著差异 ,P<0 .0 5 ) ,住院期间严重心律失常、心力衰竭、心源性休克发生率及病死率均低于梗塞前无心绞痛组 (两组间有显著差异 ,P<0 .0 5 )。结论　急性心肌梗塞发病 72小时以前有心绞痛病史对心肌具有明显的保护作用。     

梗塞前48小时内心绞痛发作对初次心肌梗塞近期预后的影响

本文对３９７例初次心肌梗塞患者根据其发病前４８小时内有无心绞痛分组，比较其并发症和近期转归。有心绞痛组（ＰＡＰ组）１７４例，无心绞痛组（对照组）２２３例，两组基本临床情况类似，ＰＡＰ组入院４８小时内及住院期间心衰与严重心律失常发生率明显低于对照组；入院４８小时内血浆ＣＰＫ峰值及住院期病死率亦低于对照组，可能与心脏缺血预适应有关。     

Increased plasma level of soluble E-selectin in acute myocardial infarction

BACKGROUND: E-selectin, also known as endothelial cell leukocyte adhesion molecule-1, is a member of the selectin family of adhesion molecules and is expressed on vascular endothelial cells in inflammatory reactions. The induction of surface E-selectin expression by endothelial cells is considered a marker of activation. METHODS AND RESULTS: We examined the plasma soluble E-selectin (sE-selectin) level in 41 patients within 6 hours after the onset of acute myocardial infarction (AMI) and in 37 patients with stable exertional angina and 27 control patients. Blood samples were obtained on admission, after reperfusion therapy, and at 4 hours, 8 hours, 12 hours, 24 hours, 48 hours, 3 days, 5 days, 1 week, and 2 weeks after admission in the AMI group. In this group, 21 patients had a history of prodromal unstable angina before infarction and 20 had sudden onset of infarction. The plasma sE-selectin level (ng/mL) on admission was higher in the AMI group than in the stable exertional angina group and control group (38.5 +/- 3.1 vs 28.5 +/- 1.5, P <.01, 26.0 +/- 1.8, P <.01, respectively). In addition, plasma sE-selectin levels were higher in the patients with AMI with prodromal unstable angina than in those with a sudden onset of infarction on admission (44.7 +/- 5.4 vs 32.0 +/- 2.1, P <.05). The plasma sE-selectin level decreased slowly during the chronic phase both in patients with AMI with prodromal unstable angina (from 44.7 +/- 5.4 to 33.8 +/- 3.4, P <.01) and those with a sudden onset of infarction (from 32.0 +/- 2.1 to 24.9 +/- 2.4, P <.01). CONCLUSIONS: These results suggest that an increase of sE-selectin may reflect enhanced endothelial cell activation in patients with AMI. The higher sE-selectin level in patients with AMI with prodromal unstable angina may have been associated with repeated episodes of myocardial ischemia and reperfusion.     

直接经皮冠状动脉介入治疗对有无梗死前心绞痛患者心肌存活性和心室收缩同步性的影响

目的　探讨直接经皮冠状动脉介入治疗 (PCI)对有无梗死前心绞痛的急性心肌梗死 (AMI)患者心肌存活性和心室收缩同步性的近期影响。方法　 87例首次 AMI患者 ,按梗死前有无心绞痛分为 3组 :A组 :无心绞痛史 30例。 B组 :梗死前 4 8h内有心绞痛史 39例。 C组 :仅在梗死前 >4 8h有心绞痛史 18例。所有患者均在发病 6 h内行直接 PCI术。术后 1周、4周行 99m　 Tc- MIBI心肌灌注断层显像 (SPECT)测定心肌存活性 ;术后 2周行 99m　 Tc心血池显像测定心室收缩同步性参数。结果　 (1) B组肌酸激酶同工酶 (CK- MB)峰值显著低于 A组 (P<0 .0 1)。 (2 ) B组放射性缺损面积 (MIA)小于 A组 (P<0 .0 5 ) ;AMI后 4周与 1周比较 ,B组 MIA显著缩小 (P<0 .0 1) ,病变区放射性计数显著增加 (P<0 .0 1) ;C组和 A组前后比较均无显著差异。 (3)心功能 :B组左心室射血分数 (L VEF)高于 A组 (P<0 .0 1) ;左心室收缩同步性 :B组左心室相角程 (L PS)低于 A组 (P<0 .0 5 ) ;以上各参数 ,C组和 A组比较均无显著差异。结论　 (1)首次急性心肌梗死前 4 8h内心绞痛发作可导致心肌缺血预适应 (ischemic preconditioning,IP)的产生 ,并可缩小心肌梗死面积 ,保护心功能。 (2 )直接 PCI可显著提高有 IP的急性心肌梗死患者的近期心肌存活性和     

Relation between the timing of the last preinfarction angina and microvascular reperfusion in patients with recanalized acute myocardial infarction

In patients with recanalized acute myocardial infarction (AMI), the relation between the timing of preinfarction angina (PA) and microvascular reperfusion remains unclear. A total of 186 patients (114 with anterior and 72 with inferior AMI) who had total occlusion and TIMI 3 recanalization < or = 6 hours from the onset of AMI were divided into 4 groups according to the time interval between the last episode of PA and the onset of AMI: < or = 2 hours (group A, n = 52); 2 to 48 hours (group B, n = 43), > or = 48 hours (group C, n = 33), and no PA (group D, n = 58). The angiographic myocardial blush grade, a marker of microvascular reperfusion, was retrospectively assessed immediately after recanalization. There were no differences in baseline characteristics, except for sex among the 4 groups. Myocardial blush grade 3 was more frequent (42% vs 21%, 9%, and 14%) and peak creatine kinase was lower (2659 vs 3455, 4422, and 4622 mU/mL) in group A than in groups B, C, and D (all P < 0.05). Multivariate analysis showed that PA occurring < or = 2 hours before AMI (OR 3.88, P < 0.05), a smaller summed ST-segment elevation before recanalization (OR 0.84, P < 0.01), earlier time to recanalization (OR 0.52, P < 0.05), and interior AMI (OR 4.87, P < 0.05) were independently associated with adequate microvascular reperfusion. We conclude that PA < or = 2 hours before the onset of AMI is independently associated with adequate microvascular reperfusion after recanalization in patients with AMI.     

急性心肌梗塞发生中肿瘤坏死因子的作用探讨

本文观察了22例AMI患者及免心便模型血浆中TNF的含量变化，以研究TNF对心肌梗塞坏死面积的影响。结果发现：（1）AMI患者心肌梗塞早期血浆TNFα迅速升高，高峰在胸痛发作后4小时，显著高于正常对照组（P＜0．001），以后逐渐下降，48小时与正常对照组比较无差异（P＞0．05）。（2）在免心梗模型中，用TNF单克隆抗体中和血浆中的TNF后，坏死区占缺血区和坏死区占左心室的体积百分比ATM组显著低于AMI组（P＜0．01）。提示：TNFα在AMI发生中起重要作用，TNFα单克隆抗体可显著减少心肌梗塞范围。     

Clinical evaluation of coronary lesion characteristics in acute myocardial infarction

Coronary lesion instability at the onset of acute myocardial infarction (AMI) was evaluated. The mechanism of AMI has been considered to be coronary lesion instability with occlusive thrombus, although more than one half of AMI occurs in clinically stable patients. A total of 313 AMI patients treated by primary percutaneous transluminal coronary angioplasty with provisional stenting (rate, 41%) were studied. They were divided into 2 groups: group 1A (n = 211), without unstable angina before AMI onset, and group 1B (n = 102), with unstable angina before onset. Moreover, angina patients treated similarly were studied: group 2A (n = 180), with stable angina, and group 2B (n = 204), with unstable angina. Coronary lesion instability at AMI onset was also predicted by C-reactive protein (CRP) levels within 6 hours after onset, before they were affected by myocardial damage. The incidence of repeated AMI and/or target vessel revascularization was 1.9% in group 1A, 7.8% in 1B (p=0.035), 1.7% in 2A, and 5.9% in 2B (p=0.043). Event-free survival curves were consistent with each other in groups 1A and 2A and in groups 1B and 2B. CRP levels on admission were 2.0 +/- 1.7 mg/L in group 1A, 3.3 +/- 4.8 mg/L in group 1B (p<0.001), 2.1 +/- 1.7 mg/L in group 2A, and 3.4 +/- 4.7 mg/L in group 2B (p<0.001). Thus coronary lesion characteristics at AMI onset appeared to be similar in groups 1A and 2A and in groups 1B and 2B. A substantial number of patients have stable culprit lesions at the onset of AMI.     

急性心肌梗死和不稳定性心绞痛患者粘附分子及相关因素的研究

目的　探讨急性心肌梗死 (AMI)和不稳定性心绞痛 (UAP)患者发病早期和 1周可溶性细胞间粘附分子 1(sICAM 1)、可溶性血管细胞粘附分子 1(sVCAM 1)、D 二聚体、血小板第 4因子 (PF4 )的动态变化及其相互关系。方法　测定 40例AMI、45例UAP患者发病 2 4h和 1周时血清sICAM 1、sVCAM 1、D 二聚体、PF4 并与 30例对照组比较。结果　AMI和UAP患者于发病 2 4h和 1周时sICAM 1、sVCAM 1、D 二聚体、PF4 均明显高于对照组 (P<0 0 1)。AMI组中 ,溶栓再通者与未溶栓者sICAM 1、sVCAM 1、D 二聚体、PF4 比较 ,差异无显著性意义 (P>0 0 5 )。AMI溶栓组中再通后与再通前相比 ,sICAM 1、sVCAM 1、D 二聚体均明显下降 (P <0 0 5 ) ;AMI、UAP组于发病 2 4h及 1周时sICAM 1与sVCAM 1均具有正相关性 (P <0 0 1) ,PF4 与sICAM 1、sVCAM 1、D 二聚体间亦具有正相关性 (P <0 0 1)。结论　AMI、UAP从发病早期至 1周sICAM 1、sVCAM 1持续升高 ,以AMI更为明显 ,表明炎症参与心肌细胞损伤过程     

冠状动脉支架术对冠心病患者血小板活化功能的影响

目的探讨冠心病患者行冠状动脉内支架置入术前后血小板活化指标的变化,了解冠心病不同临床类型支架置入数与血小板活化指标之间的关系。方法利用流式细胞术和单克隆抗体测定48例稳定型心绞痛、45例不稳定型心绞痛患者与37例急性心肌梗死患者外周血中血小板膜糖蛋白CD62p、CD63和凝血酶敏感蛋白的阳性表达率,并与45例冠状动脉造影正常者作对照分析。结果稳定型心绞痛患者、不稳定型心绞痛患者和急性心肌梗死患者支架置入后CD62p、CD63和凝血酶敏感蛋白的阳性表达率均显著高于支架置入前(P<0.01);不稳定型心绞痛组和急性心肌梗死组治疗前亦高于对照组(P<0.01),而稳定型心绞痛组治疗前与对照组比较差异无显著性(P>0.05)。稳定型心绞痛组和不稳定型心绞痛组CD62p、CD63和凝血酶敏感蛋白的阳性表达率与支架置入个数有关,置入支架越多阳性表达率越高。结论不稳定型心绞痛患者及急性心肌梗死患者存在血小板高活化状态、动脉粥样硬化斑块破裂以及急性血栓形成。支架置入术对冠状动脉内皮的损伤加强了血小板的活化,增加了血栓形成的风险。