急性心肌梗死经皮冠状动脉介入治疗患者心肌胶原与左心室重构的关系

目的探讨急性心肌梗死经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者心肌胶原变化与左心室重构关系。方法选择2011年12月至2012年9月入住宝安区人民医院的急性心肌梗死患者共70例为研究对象。按照入院后患者是否行直接PCI治疗分为直接PCI治疗组(n=30)和择期PCI治疗组(n=30),其中10例(其中直接PCI治疗组5例,择期PCI治疗组5例)患者出院后不愿意随访。所有入选患者术前、术后3 d及术后30 d均分别以酶联免疫吸附法测定血清Ⅰ型C端胶原前肽(carboxy-terminal propeptide of type I procollagen,PICP)、Ⅲ型N端胶原前肽(amino-terminal propeptide of type III procollagen,PⅢNP)和Ⅰ型C端胶原末肽(carboxy-terminal telopeptide of collagen type I,CITP)浓度;术后3 d、术后30 d均行心脏超声检查;术后30 d行单光子发射计算机断层显像测量心肌梗死面积。结果术后30 d直接PCI治疗组血清PICP、PⅢNP、CITP浓度较择期PCI治疗组明显降低,差异有统计学意义PICP:(7.76±1.47)ng/mL vs.(10.73±1.67)ng/mL,P﹤0.05;PⅢNP:(11.17±4.72)ng/mL vs.(37.80±6.83)ng/mL,P﹤0.05;CITP:(31.18±6.78)ng/mL vs.(45.10±9.70)ng/mL,P﹤0.05]。术后30 d直接PCI治疗的左心室舒张末期内径、左心室收缩末期内径、心肌梗死面积明显低于择期PCI治疗组(46.57±6.10)mm vs.(52.63±6.50)mm,P﹤0.05;(34.25±4.86)mm vs.(37.33±3.56)mm,P﹤0.05;22.8%±3.4%vs.28.2%±6.8%,P﹤0.05]。结论直接PCI治疗可有效地挽救濒死的心肌,减轻心室重构,保护心功能,改善患者远期预后。检测血清心肌胶原浓度能作为预测心室重构的指标。

Relationship between cardiac collagen and left ventricular remodeling in patients with acute myocardial infarction performed percutaneous coronary intervention

Objectives To investigate the relationship between cardiac collagen and left ventricular remodeling in patients with acute myocardial infarction undergoing pereutaneous coronary intervention （PCI）. Methods A total of 70 patients with acute myocardial infarction were selected from December 2011 to September 2012 in People＇s Hospital of Baoan. They were divided into primary PCI group （n=30） and elective PCI group （n=30）, except 10 patients （5 in primary PCI group and 5 in elective PCI group ） who objected to be followed up. Before PCI, on the 3rd day and the 30th day after PCI, serum concentrations of carboxy-terminal propeptide of type I procollagen （PICP）, amino-terminal propeptide of type III procollagen （P Ill NP） and carboxy-terminal telopeptide of collagen type I （CITP） were measured by enzyme-linked immunosorbent assay respectively. Before PCI and 30 days after PCI, all the patients were performed ultrasound, and single-photon emission computed tomography was performed to estimate myocardial infarct size. Results On the 30th day after PCI, serum myocardial collagen levels were significantly lower in primary PCI group compared with those in elective PCI group PICP： （7.76±1.47） ng/mL vs. （10.73±1.67） ng/mL, P〈 0.05; PIIINP： （11.17±4.72） ng/mLvs. （37.80±6.83） ng/mL, P〈 0.05; CITP： （31.18±6,78） ng/rnLvs. （45.10±9.70） ng/mL, P〈 0.05 ±. There were obviously smaller left ventrieular end-diastolic diameter （LVEDD）, left ventricular end-systolic diameter （LVESD） and infarct size in primary PCI group compared with those in elective PCI group （46.57±6.10） mm vs. （52.63±6.50） mm, P 〈 0.05;（34.25±4.86） mm vs. （37.33-±3.56） mm,P 〈 0.05 ;22.8%±3.4% vs.28.2%± 6.8% ,P 〈 0.05]. Conelusions Primary PCI can effectively save dying myocardial cells, reduce ventricular remodeling, protect the heart function and improve patient＇s outcomes. Detection of myocardial collagen can effectively predict left ventricular remodeling.