PCI介入时机选择对心肌梗死患者室壁瘤逆转及MMP-9、P选择素水平的影响
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摘要
目的:探讨不同PCI介入时机选择对心肌梗死患者室壁瘤逆转及MMP-9、P选择素水平的影响。方法:选取2010年3月~2016年3月收入我院的210例急性心肌梗死患者为研究对象,所有患者均经左心室合影确定合并室壁瘤。根据冠状动脉介入治疗施治时间依次分为A组(发病至PCI施治<3 h,25例)、B组(3 h≤发病至PCI施治<6 h,67例)、C组(6 h≤发病至PCI施治<12 h,88例)、D组(12 h≤发病至PCI施治≤1周,30例)。4组患者于PCI后即行导管法左心室造影,术后1周时行平衡法核素心室造影,测定患者左心室收缩、舒张功能相关参数以及反常室壁容积指数;6个月时重复上述检查;同时检测PCI治疗前后不同时间点MMP-9和P选择素水平,并随访3年,记录主要心脏事件(MACE)的发生率。结果:PCI治疗6个月后,A、B、C三组相角程及半高宽水平均显著低于D组,而左心射血分数均明显高于D组,差异有统计学意义(P<0.05);A组反常容积消失率(16/25,64%)明显高于B组(17/67,25.4%)、C组(13/88,14.8%)、D组(3/30,10.0%);组间PVI比较结果显示,A组(12.5±2.8)%、B(15.8±3.3)%、C组(15.5±3.1)%、D组(20.9±3.7)%,差异具有统计学意义(P<0.05);A组患者治疗后3 d、7 d的MMP-9和P选择素水平明显低于D组患者,差异具有统计学意义(P<0.05)。而B、C两组治疗后各时间点比较均无统计学差异,但均低于D组(P>0.05);住院期间和PCI治疗后3年随访结果显示,D组的心绞痛发生率、死亡率明显高于A、B、C三组,差异具有统计学意义(P<0.05)。结论:急性心肌梗死患者较早的接受冠脉介入干预,开通梗死动脉,能够有效逆转室壁瘤形成,同时降低机体MMP-9和P选择素水平,改善病人心功能和预后。
Objective: To explore the influence of the different timing of percutaneous coronary intervention on plasma MMP and Ps in acute myocardial infarction patients with aneurysm. Methods: 210 cases of acute myocardial infarction patients with aneurysm from March 2010 to March 2016 in our hospital were selected as the research objects and divided into group A( 25 cases,< 3 h),group B( 67 cases,6 h≤and < 12 h),group C( 88 cases,6 h≤and < 12 h) and group D( ≥12 h and < 1week; 30 cases),according to the time accepting PCI. Associated parameters of left ventricular systolic and diastolic function in patients and PVI were measured by left ventricle angiography and echocardiography at the baseline and 6 months after PCI. The level of MMP-9 and Ps were measured at different times before and after the PCI. 3-years follow-up was finished after PCI,and MACE were recorded.Results: 6 months after PCI,PS and FWHM in groups A,B,C were significantly lower than those in group D,while LVEF was higher in groups A,B,C( P < 0. 05); in the 6th month after PCI,the PVI was significantly lower in group A( 12. 5 ± 2. 8) % than in groups B( 15. 8 ± 3. 3) %,C( 15. 5 ± 3. 1) %,D( 20. 9 ± 3. 7) %( P < 0. 05);The level of MMP-9 and Ps at 3 d,7 d after myocardial infarction was significantly lower in group A than in group D( P < 0. 05); while no significant difference was found between group C and group D; Within the 3-years followup,the incidence of MACE and the mortality were significantly lower in groups A,B,C than in group D( P <0. 05). Conclusion: In patients with acute myocardial infarction received early coronary intervention,recanalization of the infarct artery can effectively reverse the left ventricular aneurysm formation,and decrease the MMP-9and P selectin,improve cardiac function and prognosis of patients.
Objective: To explore the influence of the different timing of percutaneous coronary intervention on plasma MMP and Ps in acute myocardial infarction patients with aneurysm. Methods: 210 cases of acute myocardial infarction patients with aneurysm from March 2010 to March 2016 in our hospital were selected as the research objects and divided into group A( 25 cases,< 3 h),group B( 67 cases,6 h≤and < 12 h),group C( 88 cases,6 h≤and < 12 h) and group D( ≥12 h and < 1week; 30 cases),according to the time accepting PCI. Associated parameters of left ventricular systolic and diastolic function in patients and PVI were measured by left ventricle angiography and echocardiography at the baseline and 6 months after PCI. The level of MMP-9 and Ps were measured at different times before and after the PCI. 3-years follow-up was finished after PCI,and MACE were recorded.Results: 6 months after PCI,PS and FWHM in groups A,B,C were significantly lower than those in group D,while LVEF was higher in groups A,B,C( P < 0. 05); in the 6th month after PCI,the PVI was significantly lower in group A( 12. 5 ± 2. 8) % than in groups B( 15. 8 ± 3. 3) %,C( 15. 5 ± 3. 1) %,D( 20. 9 ± 3. 7) %( P < 0. 05);The level of MMP-9 and Ps at 3 d,7 d after myocardial infarction was significantly lower in group A than in group D( P < 0. 05); while no significant difference was found between group C and group D; Within the 3-years followup,the incidence of MACE and the mortality were significantly lower in groups A,B,C than in group D( P <0. 05). Conclusion: In patients with acute myocardial infarction received early coronary intervention,recanalization of the infarct artery can effectively reverse the left ventricular aneurysm formation,and decrease the MMP-9and P selectin,improve cardiac function and prognosis of patients.
引文
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[11]翟虹,王春梅,穆玉明,等.室壁瘤形成过程中基质金属蛋白酶-9与心功能及室壁瘤容积相关性研究[J].重庆医学,2015,44(32):4487-4489.
[12]吴鹏翠,阳军,陈然,等.NT-pro BNP和MMP-9与急性心肌梗死患者早期左室重构的相关性研究[J].医学临床研究,2015,32(3):540-542.
[13]孙飞,刘长青,胡高频,等.急性前壁心肌梗死患者发病至经皮冠状动脉介入治疗时间对基质金属蛋白酶和左心室重构的影响[J].中华老年医学杂志,2015,34(9):939-942.
[14]王裕勤,吴佳源,段世英,等.不同时间窗急诊冠状动脉介入治疗对急性ST段抬高心肌梗死患者预后的比较[J].临床内科杂志,2016,33(6):410-412.
[15]KOROSOGLOU G,HAARS A,HUMPERT P M,et a1.Evaluation of myocardial perfusion and deformation in patients with acute myocardial infarction treated with primary angioplasty and stent placement[J].Coronary Artery Dis,2008,19(7):497-506.
[16]刘俭雄,石理,李军,等.急性心肌梗死PCI治疗后血清基质金属蛋白酶9、C反应蛋白、P选择素的变化及意义[J].山东医药,2016,56(5):64-65.
[2]MORI M,SAKAKURA K,WADA H,et al.Left ventricular apical aneurysm following primary percutaneous coronary intervention[J].Heart&Vessels,2012,28(6):677-683.
[3]胡晓峰,杨明,李贵森,等.冠脉介入术对急性心肌梗死患者血浆CRP、MMP-9及P选择素浓度的影响[J].宁夏医科大学学报,2015,37(5):591-593.
[4]饶志荣,方快发,刘文兵,等.急性ST段抬高型心肌梗死介入治疗对脑利钠肽及心室重构的影响[J].海南医学,2013,24(7):946-948.
[5]高润霖.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[6]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会,等.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[7]杨跃进,杨进刚.AHA/ACC 2009年ST段抬高心肌梗死和经皮冠状动脉介入治疗指南更新解读[J].心血管病学进展,2010,31(2):159-161.
[8]张明明,徐延玲,王孝福,等.瑞舒伐他汀对不稳定型心绞痛患者经皮冠状动脉介入治疗后心肌损伤标志物、炎性因子及可溶性P选择素的影响研究[J].实用心脑肺血管病杂志,2016,24(2):12-15.
[9]孙飞,刘长青,胡高频,等.急性前壁心肌梗死患者发病至经皮冠状动脉介入治疗时间对基质金属蛋白酶和左心室重构的影响[J].中华老年医学杂志,2015,34(9):939-942.
[10]唐念中,陈少萍,王君,等.不同剂量ASA对PCI术后患者血浆TXB2和P选择素水平的影响[J].现代生物医学进展,2014,14(25):4869-4872.
[11]翟虹,王春梅,穆玉明,等.室壁瘤形成过程中基质金属蛋白酶-9与心功能及室壁瘤容积相关性研究[J].重庆医学,2015,44(32):4487-4489.
[12]吴鹏翠,阳军,陈然,等.NT-pro BNP和MMP-9与急性心肌梗死患者早期左室重构的相关性研究[J].医学临床研究,2015,32(3):540-542.
[13]孙飞,刘长青,胡高频,等.急性前壁心肌梗死患者发病至经皮冠状动脉介入治疗时间对基质金属蛋白酶和左心室重构的影响[J].中华老年医学杂志,2015,34(9):939-942.
[14]王裕勤,吴佳源,段世英,等.不同时间窗急诊冠状动脉介入治疗对急性ST段抬高心肌梗死患者预后的比较[J].临床内科杂志,2016,33(6):410-412.
[15]KOROSOGLOU G,HAARS A,HUMPERT P M,et a1.Evaluation of myocardial perfusion and deformation in patients with acute myocardial infarction treated with primary angioplasty and stent placement[J].Coronary Artery Dis,2008,19(7):497-506.
[16]刘俭雄,石理,李军,等.急性心肌梗死PCI治疗后血清基质金属蛋白酶9、C反应蛋白、P选择素的变化及意义[J].山东医药,2016,56(5):64-65.