缺血后处理对急性心肌梗死患者血清神经生长因子和心肌梗死面积的影响

目的探讨缺血后处理对急性心肌梗死(AMI)患者血清神经生长因子(NGF)和心肌梗死面积的影响及意义。 方法选择2016年1月至2019年12月吉林市中心医院心内科收治的200例发病12 h内的AMI患者，且急诊行经皮冠状动脉介入(PCI)治疗，采用随机数字表法，分为缺血后处理组和对照组，各100例。缺血后处理组采用球囊预扩张反复充盈、回吸的方法，实现梗死相关动脉的缺血再灌注处理，对照组则给予常规PCI术。比较两组患者血清心肌损伤标记物、NGF水平和心肌梗死面积。 结果入院时，缺血后处理组血清肌酸激酶同工酶(CK-MB)[(96.55±4.68)U/L]、心肌肌钙蛋白I(cTnI)[(21.03±2.25)μg/L]和血清NGF水平[(0.13±0.06)ng/L]与对照组[(97.38±5.46)U/L、(21.24±2.36)μg/L、(0.12±0.04)ng/L]比较，均差异无统计学意义(t＝1.15，0.64，1.39；均P>0.05)。入院后3 d，缺血后处理组cTnI水平[ (22.96±2.46)μg/L]低于对照组[(39.85±3.68)μg/L]，CK-MB[(101.28±3.46)U/L]、血清NGF水平[(0.22±0.03)ng/L]高于对照组[(93.50±5.68)U/L、(0.14±0.06)ng/L]，均差异有统计学意义(t＝38.16，11，70, 11.93 ；均P<0.05)。入院后7 d和14 d，缺血后处理组CK-MB[(13.43±2.35)U/L、(4.23±1.38)U/L]、cTnI[(6.33±1.38)μg/L、(0.78±0.14)μg/L]和血清NGF水平[(0.14±0.04)ng/L、(0.12±0.04)ng/L]均低于对照组[CK-MB(15.48±4.96)U/L、(6.47±1.35)U/L；cTnI(7.75±2.47)μg/L、(1.15±0.39)μg/L；NGF(0.22±0.05)ng/L、(0.19±0.05)ng/L]，均差异有统计学意义(t＝3.74，11.60，5.02，8.93，12.49，10.93；均P<0.05)。AMI发病6个月后，两组间不同心肌梗死面积人数比较，差异有统计学意义(χ²＝50.08，P<0.05)。 结论经缺血后处理的AMI患者血清NGF水平呈动态变化，峰值提前，可做为缺血后处理有效及判断预后的指标。缺血后处理可有效减少AMI患者心肌梗死面积。

Effects of ischemic postconditioning on serum nerve growth factor and myocardial infarction area in patients with acute myocardial infarction

ObjectiveTo investigate the effect and significance of ischemic postconditioning methods on serum nerve growth factor (NGF) and myocardial infarction area in patients with acute myocardial infarction (AMI). MethodsFrom January 2016 to December 2019, 200 cases with AMI within 12 hours in Cardiology Department of Jilin Central Hospital were selected, and percutaneous coronary intervention (PCI) treatment was performed in the Emergency Department. They were randomly divided into ischemic postconditioning group (n=100) and control group (n=100) by random number table method. The ischemic postconditioning group used balloon pre-expansion and repeated filling and re-inhalation to achieve reperfusion ischemia treatment of infarct-related arteries, while the control group was given conventional PCI. The serum markers of myocardial injury levels, NGF levels and myocardial infarction areas were compared between the two groups. ResultsAt admission, the serum levels of creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI) and NGF of ischemic postconditioning group were (96.55±4.68)U/L, (21.03±2.25)μg/L and (0.13±0.06)ng/L, respectively. Comparing with the control group [(97.38±5.46)U/L, (21.24±2.36)μg/L, (0.12±0.04)ng/L], the differences were not statistically significant (t=1.15, 0.64, 1.39, all P>0.05). Three days after admission, cTnI level [(22.96±2.46)μg/L] in the ischemic postconditioning group was lower than that in the control group [(39.85±3.68)μg/L], CK-MB [(101.28±3.46)U/L] and serum NGF [ (0.22±0.03)ng/L] levels were higher than those in the control group [ (93.50±5.68)U/L, (0.14±0.06)ng/L], the differences were statistically significant (t=38.16, 11, 70, 11.93, all P<0.05). Seven days and 14 days after admission, CK-MB [(13.43±2.35)U/L, (4.23±1.38)U/L], cTnI[(6.33±1.38)μg/L, (0.78±0.14)μg/L] and serum NGF [(0.14±0.04)ng/L, (0.12±0.04)ng/L] levels of ischemic postconditioning group were lower than those in the control group [CK-MB (15.48±4.96)U/L, (6.47±1.35)U/L, cTnI (7.75±2.47)μg/L, (1.15±0.39)μg/L, NGF (0.22±0.05)ng/L, (0.19±0.05)ng/L], the differences were statistically significant (t=3.74, 11.60, 5.02, 8.93, 12.49, 10.93, all P<0.05). After 6 months, the number of cases with different myocardial infarction areas between the two groups was statistically significant (χ²=50.08, P<0.05). ConclusionsSerum NGF level in AMI patients undergoing ischemic postconditioning shows a dynamic change, and the peak of NGF level comes earlier, which can be used as an indicator of effectivity and prognosis. The ischemic postconditioning can effectively reduce the area of myocardial infarction in patients with AMI.