急性心肌梗死直接PCI后心电图ST段回落幅度与血管内皮功能的关系

目的:探讨急性心肌梗死(AMI)直接经皮冠状动脉介入术(PCI)后心电图ST段回落幅度与血管内皮功能的关系。方法:AMI直接PCI后梗死相关血管(IRA)血流达TIMI3级患者51例,按ST段回落幅度分为A组32例(ST段迅速回落组)和B组19例(ST段持续抬高组)。所有患者于发病(7±2)d和3个月测量肱动脉流量介导舒张(FMD)和硝酸甘油介导舒张(NMD)。正常对照组25例。结果:AMI发病1周时A组和B组FMD(5·42%±2·27%与1·99%±1·63%,P<0·05)和NMD(15·08%±8·79%与6·84%±3·92%,P<0·05)均明显低于正常对照组(FMD9·60%±3·41%,NMD22·17%±8·49%);AMI发病后3个月A、B2组的FMD(9·06%±1·98%与5·44%±1·91%,P<0·01)和NMD(20·90%±5·78%与12·93%±4·71%,P<0·01)均较基础状态增加,A组内皮功能基本恢复正常,B组虽然有恢复但未达到正常状况。结论:AMI血管内皮功能明显受损,成功再灌注后ST段持续抬高的患者受损更明显。随着时间的延长内皮功能有所恢复,ST段持续抬高的患者恢复差于ST段迅速回落者。

The relationship between ST segment elevation resolution in electrocardiogram and vascular endothelial function in patients with acute myocardial infarction received direct PCI

Objective:To observe the relationship between ST segment elevation resolution in electrocardiogram and vascular endothelial function in patients with acute myocardial infarction (AMI) who received direct percutaneous coronary intervention (PCI).Method:Fifty-one cases with AMI who received direct PCI and residual stenosis <30% were divided into two groups according to ST segment elevation resolution(STR), group A:STR≥50%,32 cases; group B:STR<50%,19 cases. Flow mediated dilation(FMD) and nitroglycerin mediated dilation(NMD) were measured at day 7±2 and 90 after AMI. 25 healthy as control group also measured FMD and NMD.Result:1.FMD (5.42%±2.27% vs 1.99%±1.63%,P<0.05) and NMD (15.08%±8.79% vs 6.84%±3.92%,P<0.05) were significantly lower in group B than that of group A at acute stage. FMD and NMD were all significantly lower in group A and B than that of control group (FMD: 9.60%±3.41%,NMD:22.17%±8.49%).2.FMD(9.06%±1.98% vs 5.44%±1.91%,P<0.01) and NMD (20.90%±5.78% vs 12.93%±4.71%,P<0.01) of group A and B were all increased than that of baseline in convalescence. Endothelial function of group A recovered to normal level and group B not get normal level.Conclusion:Vascular endothelial function were significantly injuried at acute stage in patients with AMI, specially in patients with ST segment persistent elevation after received successful reperfusion. Endothelial function of group A and B were all recovered at convalescence, recovery of group B were worse than that of group A.