妊娠相关血浆蛋白A对急性心肌梗死自发性再通作用的临床研究

【目的】检测急性心肌梗死自发性再通冠状动脉和无再通冠状动脉血妊娠相关血浆蛋白A（pregnancy-associated plasma protein-A,PAPP-A）浓度及冠状动脉抽吸组织mRNA表达水平,探索炎症反应对自发性再通的作用。【方法】2008年3月-2010年6月,行直接介入治疗的急性ST抬高性心肌梗死并经TIMI血流分级为2~3级的患者共30例,为梗死相关动脉自发性再通组（SR组）。另选TIMI血流0-1级,一般临床情况与SR组匹配的急性心肌梗死患者30例为无再通组（NSR组）。记录所有入选本研究对象的一般临床指标。冠状动脉造影之后,抽吸梗死相关动脉血,并留取抽吸组织,ELISA法测定PAPP-A浓度,实时定量PCR法检测抽吸组织PAPP-A mRNA表达水平。【结果】两组一般临床情况无统计学差异（P〉0.05）。SR组冠脉PAPPA浓度（0.56±0.17）ng/ml明显低于NSR组（0.82±0.26）ng/ml（P〈0.01）,SR组PAPP-A mRNA表达低于NSR组（P〈0.05）。【结论】PAPP-A可能是影响自发性再通的原因之一,炎症反应的强弱与急性心肌梗死自发性再通相关。

Impact of pregnancy-associated plasma protein-A on the spontaneous reperfusion of actue myocaidial infarction

[ Objective ] The present study was to investigate inflammatory response, focusing on pregnancy-associated plasma protein- A （PAPP-A） levels in coronary circulation. [ Methods ] From Mar 2008 to Jun 2010, thirty ST segment elevation myocardial infarction （STEMI） patients with a TIMI grade of 2-3 during coronary angiography were consecutively enrolled to SR group. Another thirty STEMI patients with a TIMI grade of 0-1 were enrolled to NSR group. All patients were provided with informed consent, and were scheduled for direct PCI. During direct PCI procedure, blood from infarcted related artery （IRA） was sucked with Zeek catheter.PAPP-A levels in coronary suctions were determined by ELISA. Total RNA was extracted from coronary suctions to determine PAPP-A mRNA expression levels by real-time quantitative PCR. [Results] No significant difference was found between two sets of general clinical conditions （P 〉 0.05）. Coronary concentration of PAPP-A was significantly reduced in SR group [（0.56 ± 0.17） ng/ml vs. （0.82 ±0.26） ng/ml, P 〈 0.01] compared with NSR group. This change was paralleled with the change of mRNA level in coronary extractions （P 〈 0.05）. [Conclusion] Spontaneous reperfusion in infarct related artery after AMI may be ascribed to lower coronary PAPP-A level, intervention in acute myocardial infarction inflammatory response may be a key means to improve the spontaneous reperfusion.