摘要
目的 研究急性冠状动脉综合征(Acute Coronary Syndrome，ACS)患者发病不同阶段血浆神经肽Y(Neuropeptide Y,NPY)水平的变化，探讨其与冠心病心肌缺血的关系，并观察卡维地洛(Carredil01)对ACS患者NPY含量的影响。
方法 选取ACS患者62例，其中急性Q波性心肌梗死患者28例、急性非Q波性心肌梗死患者14例和不稳定型心绞痛患者20例，每一类型ACS患者皆随机分成2组：一组应用卡维地洛，为治疗组；一组未用，为对照组。用放射免疫分析(Radio Immunoassay,RIA)方法测定其发病不同阶段血浆NPY浓度水平，并选20例健康者作为正常对照组。
结果 ACS患者发病初期血浆NPY水平均明显高于正常对照组和治疗2周后病情稳定期(p＜0.01)；应用卡维地洛治疗2周后的不稳定型心绞痛患者血浆NPY水平与对照组比较，差异有统计学意义(p＜0.05)；急性心肌梗死患者血浆NPY水平在心梗开始后即开始升高，3d左右达高峰(220.1±29.6pg／ml)，7d左右恢复至正常水平(142.7±41.8pg／ml)，经卡维地洛治疗组均较对照组NPY水平下降迅速。
结论 ACS患者发病时，血浆NPY水平升高，提示NPY参与了ACS的病理生理过程，NPY可作为观察ACS患者病情变化的一项指标。卡维地洛能有效拮抗NPY的缩血管作用，对改善ACS患者心肌氧供需失衡有重要作用。
Objective The relation between the plasma Neuropeptide Y(NPY) level and the myocardial ischemia in patients with acute coronary syndrome(ACS) and the effect of carvedilol on the plasma concentration of NPY in these patients were studied.
Methods 62 cases of ACS patients including 28 patients with Q-wave AMI, 14 patients with non- Q-wave AMI and 20 patients with UA were involved in this study. Eath group was randomly divided into 2 groups, carvedilol-treated group and non-carvedilol-treated group. The plasma NPY concentrations were determined by radioimmunoassay (RIA) before and after treatment. 20 normal person's plasma NPY were measured as the normal control. Datas were analyzed by SPSS 11.5 soft ware using the methods of one-way ANOVA and linear regression.
Results NPY level significantly increased in patients with ACS compared with that in normal control (all p<0.01). The NPY levels of patients with AMI (24h) and UA are significantly higher than that of normal controls and that of post 2 weeks treatment (p<0.05). The NPY level of patients with AMI is elevated from the beginning of AMI and reached the peak level at 3d after AMI, then declined to normal in 7d. After treatment of carvedilol NPY level was significantly decreased.
Conclusion When ACS occurs, the plasma level of NPY is elevated. This suggests NPY may participate the pathophysiological course of ACS. The plasma NPY level may be a marker for judge the myocardial ischemia status of ACS patients. Carvedilol may improve the imbalance between myocardial oxygen supply and need in patients with ACS and also markedly antagonize the vasoconstriction of NPY.
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