再灌注心律失常对急性心肌梗死患者心肌细胞凋亡和左室重构的影响

目的探讨急性心肌梗死（AMI）患者再灌注心律失常（RA）、心肌细胞凋亡和左室功能的关系。方法156例经急诊再灌注治疗的AMI患者,分为RA组58例（24小时内出现RA）,非再灌注心律失常（Non．RA）组98例。应用ELISA方法,分别检测再灌注治疗成功后即刻、7天和2—4周血清细胞凋亡信号分子Fas／APO-1水平,并在1周、6个月和1年做心脏彩超,检测左室射血分数（LVEF）和左室舒张末期内径（LVEDD）。结果（1）RA组血管开通时间较Non-RA组晚,且前降支病变较Non-RA组发生率高（P〈0．05）。（2）再灌注治疗成功后即刻,RA组血清Fas／APO-1浓度明显高于Non-RA组（13．82±4．36）μg/L与（8．19±3．56）μg/L,P〈0．05]。（3）再灌注治疗成功后第7天,两组患者血清Fas／APO-1浓度达高峰,2—4周时明显下降,与第7天比较差异有统计学意义RA组（10．91±3．65）μg/L与（14．26±4．98）μg/L,P〈0．05;Non-RA组（4．69±1．87）μg/L与（12．19±3．25）μg/L,P〈0．01],且2—4周时RA组Fas／APO-1浓度明显高于Non．RA组（10．91±3．65）μg/L与（4．69±1．87）μg/L,P〈0．01]。（4）AMI再灌注治疗成功后1周,RA组与Non-RA组比较,LVEF和LVEDD差异无统计学意义LVEF（47．7±9．6）％与（49．2±8．9）％,P〉0．05;LVEDD（59．7±10．3）mm与（57．4±12．4）mm,P〉0．05]。（5）AMI再灌注治疗成功1年后,Non-RA组LVEF明显高于自身急性期和RA组分别为（59．5±9．2）％、（49．2±8．9）％和（49．9±10．1）％,P〈0．05],LVEDD虽然无显著性变化（P〉0．05）,但有增加趋势。结论心肌缺血严重患者易发生RA,且与心肌缺血所诱发心肌细胞凋亡有关,影响左室功能的恢复,促进心室重构。

Effects of reperfusion arrhythmia on myocardial apoptosis and left ventricular remodeling in patients with acute myocardial infarction

OBJECTIVE: To observe plasma soluble Fas/APO-1 concentration in patients with reperfusion arrhythmia immediately after coronary reperfusion in patients with acute myocardial infarction (AMI) and to investigate the impact of reperfusion arrhythmia on left ventricular (LV) remodeling in AMI patients. To observe the relationship between cardiomyocytes apoptosis with reperfusion arrhythmia in patients with acute myocardial infarction (AMI), and investigate the impact of reperfusion arrhythmia on left ventricular (LV) remodeling in patients with AMI. METHODS: One hundred and fifty-six patients with AMI who received reperfusion therapy were selected as subjects. Fifty-eight patients underwent reperfusion arrhythmia within 24 hour after coronary reperfusion treatment (RA group). Ninty-eight patients did not occurred reperfusion arrhythmia (Non-RA group). Strepavidin-biotin ELISA was used to determine the soluble Fas/APO-1 plasma concentration at baseline, 7 day (d) and 2 - 4 week (W). All patients were followed up with scheduled evaluations of LV function and morphology with left ventriculography for 1 year. RESULTS: 1. It was later that the coronary reperfusion occurred in patients of RA group than that of Non-RA group, and the left anterior descending was more frequent infract related artery (60.3%) than of Non-RA group (36.9%, P < 0.05). 2. The Fas/APO-1 levels in patients of RA group higher than those of Non-RA group at baseline (13.82 +/- 4.36) microg/L vs (8.19 +/- 3.56) microg/L, P < 0.01]. 3. The highest level of Fas/APO-1 was on 7 d after AMI and the plasma levels of Fas/APO-1 in 2 - 4 W were slightly lower than those in 7 d in the two groups RA group: (10.91 +/- 3.65) microg/L vs (14.26 +/- 4.98) microg/L, P < 0.05; Non-RA group: (4.69 +/- 1.87) microg/L vs (12.19 +/- 3.25) microg/L, P < 0.01]. However, the Fas/APO-1 level of 2 - 4 W in RA group was slightly higher than the level in Non-RA group (10.91 +/- 3.65) microg/L vs (4.69 +/- 1.87) microg/L, P < 0.01]. 4. There was on difference between two groups in left ventricular ejection fraction (LVEF) and the left ventricular end-diastolic dimension (LVEDD) one week after AMI LVEF: (47.7 +/- 9.6)% vs (49.2 +/- 8.9)%, P > 0.05; LVEDD: (59.7 +/- 10.3) mm vs (57.4 +/- 12.4) mm, P > 0.05]. 5. In the Non-RA group, the LVEF significantly increased from 1 W phase to the 1-year phase from (49.2 +/- 8.9)% to (59.5 +/- 9.2)%, P < 0.05], but unchanged in the 58 patients without reperfusion arrhythmia from (47.7 +/- 9.6)% to (49.9 +/- 10.1)%, P > 0.05]. The LVEF of Non-RA group was slightly higher than that of RA group at 1 year (59.5 +/- 9.2)% vs (49.9 +/- 10.1)%, P < 0.05]. The LVEDD had no significant difference between two groups, but there was downtrend in the Non-RA group at 1 year after AMI. CONCLUSION: Reperfusion arrhythmia was related with cardiomyocytes apoptosis in patients with AMI, and might influence left ventricular function and promote LV remodeling.