急性前壁心肌梗死患者相关血管再通后血液中成熟型肾上腺髓质素变化研究

目的探讨急性心肌梗死(AMI)再灌注后,有活性的成熟型肾上腺髓质素(AM)在冠状窦-主动脉差值是否有变化。方法对146例首次发生急性前壁心肌梗死患者和51例冠状动脉造影阴性作对照。入选的心肌梗死患者症状出现后24 h内完成冠状动脉腔内成形术(PICA)的再灌注治疗。再灌注后取主动脉和冠状窦血,测定血浆AM的两种分子形态(AM-m和AM-Gly)。结果AMI患者主动脉和冠状窦血浆AM-m,AM-Gly水平明显高于对照组(1．7±1．4)pmol／L比(0．4±0．3)pmoL／L,P<0．01]。AMI患者血浆AM-m水平的冠状窦-主动脉差值明显高于对照组,而AM- Gly在两组之间差异无统计学意义(P=0．30)。AM-m的冠状窦-主动脉差值,在伴有左心室功能障碍的AMI患者(n=49)明显高于不伴有左心室功能障碍的AMI患者(n=97)。主动脉和冠状窦的血浆AM-m水平与左室射血分数呈负相关(r=-0．50,r=-0．48,P<0．01)。结论AMI再灌注后,尤其伴有严重左心室功能障碍的患者冠状动脉循环血液中AM的有活性的成熟型(AM-m)合成加速,提示AMI再通后AM经自分泌和(或)旁分泌可能对心血管起保护作用。

Mature-type adrenomedullin in coronary circulation immediately after reperfusion in patients with anterior acute myocardial infarction

OBJECTIVE: Levels of adrenomedullin (AM), a potent vasodilatory peptide, have been shown to increase in the early stage of acute myocardial infarction (AMI). The purpose of this study was to determine whether coronary sinus-aortic step-up of mature forms of AM is accelerated in patients with AMI after reperfusion. METHODS: The subjects were 146 consecutive patients with a first episode of anterior AMI and 51 normal controls. All patients with AMI underwent balloon reperfusion therapy within 24 h after symptom onset. Plasma levels of two molecular forms of AM (an active, mature form AM-m] and an intermediate, inactive glycine-extended form AM-Gly]) in the aorta and coronary sinus (CS) were measured by specific immunoradiometric assay after reperfusion. RESULTS: Plasma levels of AM-m and AM-Gly in the aorta and CS were higher in AMI patients than in controls. CS-aortic step-up of AM-m, which is an index of myocardial production of AM-m, was significantly greater in AMI patients than in controls (1.7 +/- 1.4) pmol/L vs (0.4 +/- 0.3) pmol/L, P < 0.01]. However, there was no significant difference in CS-aortic step-up of AM-Gly (P = 0.30). AMI patients with left ventricular dysfunction (n = 49) had a significantly higher CS-aortic AM-m step-up than AMI patients without left ventricular dysfunction (n = 97). AMm in the aorta and CS negatively correlated with the left ventricular ejection fraction (r = -0.50, r = -0.48, P < 0.01). CONCLUSION: Myocardial synthesis of AM-m is accelerated in patients with reperfused AMI, especially in patients with critical left ventricular dysfunction. Increased myocardial synthesis of active AM may protect against cardiac dysfunction, myocardial remodeling, or both after the onset of AMI.