ET-1及TXA_2水平的变化及其在急性冠脉综合征中的临床意义

目的探讨急性冠脉综合征患者介入术前、术后血浆内皮素-1（ET-1）及血栓素A2（TXA2）水平的变化及其临床意义。方法选取123例诊断为急性冠脉综合征患者,根据心肌酶水平分为不稳定心绞痛组及急性心肌梗塞组,两组患者均进行经皮内冠状动脉成形术及即刻支架植入术,分别于术前5 min及术后12 h采集外周静脉血,测试ET-1及TXA2水平。结果急性心肌梗塞组与不稳定心绞痛组相比,术前ET-1均值间差异有统计学意义（P〈0.05）,术后则差异无统计学意义;术前及术后TXA2差异均无统计学意义。但在急性心肌梗塞患者冠脉造影中显示有血栓形成的患者,血浆中TXA2含量高于无血栓形成的患者（P〈0.05）,应用血栓抽吸技术后,术后两组患者血浆中含量差异无统计学意义。结论急性心肌梗塞患者血浆中ET-1的明显升高,可能与血管痉挛、血栓形成及心肌损伤有密切关系。TXA2在急性心肌梗塞患者血浆中的明显升高,提示着更高的血栓风险,而血栓抽吸技术可能对有明确血栓形成的急性心肌梗塞患者的预后有积极意义。

Clinical significance of ET-1 and TXA2 in patients with acute coronary syndrome.

Objective To investigate the changes of endothelin-1 （ET-1） and Thromboxane A2 （TXA2） lev- els after primary percutaneous coronary intervention （PCI） in patients with acute coronary syndrome, and to analyze their clinical significance. Methods A total of 123 patients with acute coronary syndrome were divided into unstable angina group （UA group） and acute myocardial infarction group （AMI group）, according to the myocardial enzymes levels. The two groups of patients underwent successful PCI. Blood samples were collected from all patients 5 minutes before procedure and 12 hours after procedure. The ET-1 and TXAz levels were measured. Results The mean ET-1 level in AMI group and UA group showed statistically significant difference before procedure （P〈O.05）, but with no significant difference after procedure （P=-0.263）. There was no statistically significant difference in TXA2 levels be- tween the two groups before and after PCI. But the mean TXA~ level in patients that the thrombus can be seen during PCI was significantly higher than other patients in AMI group （P=0.010）. Conclusion The ET-1 plasma levels are significantly increased in patients with acute myocardial infarction, which might be related to angiospasm, thrombosis and myocardial damage. The TXA2 levels are also significantly increased, which may indicates higher risk of thrombo- sis in AMI. Thrombosis aspiration might decrease the TXA2 plasma level and benefit revascularization.