摘要
目的 探讨急性ST段抬高性心肌梗死（STEMI）患者入院时血浆基质金属蛋白酶-9（MMP-9）水平与急诊经皮冠状动脉介入术（PCI）中无复流的关系及对心功能和预后的影响.方法 96例STEMI急诊PCI治疗成功的患者,按介入治疗术中有无发生无复流（梗死相关动脉前向血流≤ TIMI 2级）分为正常血流组（68例）和无复流组（28例）,另以20例健康人作为对照组.病例组分别于入院时、术后24 h及2周采用ELISA法检测血浆MMP-9水平.2周做心脏超声,比较左室舒张末直径（LVEDd）、左室射血分数（LVEF）.随访6个月,记录主要不良心脏事件（MACE）的发生情况.结果.无复流组和正常血流组术前血浆MMP-9水平明显高于对照组（P均＜0.01）;无复流组各时点血浆MMP-9明显高于正常血流组（P均＜0.05）.术后2周做心脏超声,无复流组LVEDd高于正常血流组（P＜0.05）,LVEF低于正常血流组（P＜0.05）.主要MACE的发生情况：无复流组明显高于正常血流组（P＜0.01）.血浆MMP-9与LVEDd呈正相关（r=0.68,P＜0.01）,与LVEF呈负相关（r=-0.72,P＜0.01）.结论.AMI患者急诊PCI术前血浆MMP-9水平增高与介入术中无复流发生有关,提示心功能不良、预后差.
Objective To investigate the relatiouship between the level of plasma matrix metalloproteinase- 9 （MMP- 9） and no-reflow in emergency percutaneous coronary intervention （PCI） in acute ST- segment elevation myocardial infarction patients at admission and tile influence on cardiac function and prognosis. Methods 96 patients with acute ST - segment elevation myocardial infarction undergoing emergency PCI successfully were divided into normal reflow group （ n = 68） and no - reflow group （ n = 28） according to the occurrence of no -reflow （ the anterior blood flow of infarct related artery is ≤TIMI 2 grade） in PCI operation, while 20 heahhy human as control group. Analyzing the clinical data of all patients, including detecting the level of plasma MMP - 9 before the interventional operation, 24 hours and 2 weeks after operation using the ELISA method. We compared the end - diastolic diameter of left ventricular and left veutrieular ejection fraction using the cardiac uhrasound after 2 weeks and followed - up for 6 months to recording the major adverse cardiac, events （MACE） in all cases. Results There is no significant statistical differences about age, sex, body mass index, history of smoking, bypertension and diabetes history, the time from admission to balloon dilation, the Killip classification of heart function, eoronary blood flow between the no - reflow group and normal blood group. The plasma levels of MMP - 9 of no -reflow group and normal blood group were significantly higher than that of control group （ all P 〈 0.01 ） before operation. The plasma level of MMP - 9 at different time points of no - reflow group was significantly higher than that of normal blood group （ all P 〈 0.05 ）. The end- diastolic diameter of left ventricular of no -reflow group was higher than that of normal blood group （ P 〈 0.05 ）, while the left ventricular ejection fraction was less the normal blood group （ P 〈 0.05 ） in cardiac ultrasound after 2 weeks of operation. The happening of major adverse cardiac events （ MACE ） ： the occurrence of MACE in no - reflow group was significantly higher than that in normal blood group （P 〈 0.01 ）. The level of MMP- 9 showed a positive correlation （r = 0.68, P 〈 0.05 ） with the end -diastolie diameter and a nagtive correlation （ r = - 0.72, P 〈 0.01 ） with the left ventricular ejection fraetion. Conclusion The elevating of the level of plasma MMP - 9 before the operation of emergency PCI in patients with acute myocardial infarction is related with the occurring of no - reflow and is one of the prediction factor of no - reflow induced heart failure which suggested the worse heart funetion and poor prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2012年第2期139-142,共4页
Chinese Journal of Critical Care Medicine
