急性心肌梗死患者补救性冠状动脉支架置入对血清C-反应蛋白的影响

目的:探讨急性心肌梗死(AMI)患者静脉溶栓失败后延迟及补救性冠状动脉支架置入术对血清C-反应蛋白(CRP)的影响。方法:43例AMI且静脉溶栓失败患者分为A、B2组,A组26例溶栓后2周行冠状动脉造影并对病变血管置入冠状动脉支架;B组17例溶栓后90min急诊对“罪犯血管”补救性置入冠状动脉支架。分别于溶栓前、冠状动脉支架置入术后24h、48h、72h及第7d采集静脉血测定CRP。于入院即刻、发病后8h、10h、12h、14h、16h、24h采静脉血测定血清肌酸激酶同工酶(CK-MB)。结果:A组溶栓前CRP为(7.82±4.35)mg/L,术后24h、48h、72hCRP水平和溶栓前比较差异无统计学意义(P>0.05),术后7d((2.81±1.56)mg/L)CRP水平较溶栓前降低(P<0.01)。B组溶栓前CRP为(6.98±4.27)mg/L,补救性冠状动脉支架置入术后24h、48h、72hCRP水平高于溶栓前(P<0.01);术后第7dCRP水平与溶栓前比较差异无统计学意义(P>0.05)。A、B2组溶栓前CK-MB水平均高于正常值,2组比较差异无统计学意义(P>0.05);和A组相比,B组发病后14h、16h、24h血清CK-MB水平均降低,差异有统计学意义(P<0.05)。结论:AMI静脉溶栓失败时补救性冠状动脉支架置入术可引起血清CRP水平升高,然后缓慢降低,可能与局部炎症反应有关。

Effect of rescue coronary stent on serum C-reactive protein in patients with acute myocardial infarction

Aim: To observe the effect of rescue percutaneous coronary stent on serum C-reactive protein (CRP) in patients with acute myocardial infarction (AMI).Methods:A total of 43 patients with AMI that failed to perform thrombolysis were allocated into 2 groups. After thrombolysis therapy, group A(n=26) was performed coronary angiography and coronary stent implantation(CSI) and group B(n=17) was performed rescue coronary stent implantation(RCSI) according to the 90 min's coronary angiography. Serum CRP in both groups was determined before thrombolysis and at 1 d,2 d,3 d and 7 d after SCI or RCSI; serum CK-MB was determined at hospitalization, and 8 h, 10 h, 12 h,14 h, 16 h, and 24 h after the attack of disease.Results: In group A serum CRP had no significant difference before thrombolysis and at 1 d,2 d, and 3 d after CSI (P>0.05). Serum CRP at 7 d after CSI was lower than that before thrombolysis (P<0.01); in group B serum CRP at 1 d,2 d, and 3 d after RCSI was higher than that before thrombolysis(P<0.01). Serum CRP at 7 d after RCSI was close to that before thrombolysis. Before thromblysis CK-MB in both groups were higher than normal value, and there was no significant difference between 2 groups.Compared with group A, CK-MB in group B at 14 h, 16 h, and 24 h after the attack of disease was significantly lower(P<0.05).Conclusion: Serum CRP in patients with AMI increases obviously after RCSI, which may be related to local inflammation reaction or local injury of intima.