摘要
目的通过测定急性心肌梗死(AMI)患者早期血浆心肌肌钙蛋白I(cTnI)水平变化,结合导管法左心室造影(LVG)心室容积、压力及形态的变化,探讨cTnI在AMI后急性室壁瘤(LVA)形成患者血浆中的动态变化特点及其与LVA形成和心功能状态的关系。方法选择首次前壁AMI患者62例,根据入院即刻LVG结果将患者分为LVA形成组29例和无LVA组33例。所有受试者于发病后12小时采血检测cTnI。所有患者于经皮冠状动脉介入治疗(PCI)完成后即刻及6个月复查时均行LVG,测定左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室射血分数(LVEF)、室壁运动记分(WMS)、左心室舒张末期压(LVEDP)。随访6个月内主要恶性心脏事件(MACE)的发生率。结果 LVA形成组自AMI发作至再灌注时间较无LVA组明显延长(9.06±5.23)hvs(6.76±4.27)h(t=2.351,P<0.05)、同时KillipⅢ级心力衰竭发生率明显高于无LVA组(27.6%vs 3.0%,χ2=7.501,P<0.01)。LVA形成组血浆cTnI峰值浓度明显高于无LVA组(158.28±15.39)pg/L vs(149.15±14.62)pg/L(t=2.212,P<0.05)。PCI后即刻和术后6个月时,无LVA组LVEF、LVESVI、LVEDVI、WMS和LVEDP各参数均优于有LVA形成组(均P<0.05)。LVA形成组患者在6个月随访期间MACE发生率明显高于无LVA组患者[13(44.8%)vs 4(12.1%),χ2=6.732,P<0.01],且cTnI峰值水平与MACE发生率显著相关(r=0.561,P<0.05)。结论血浆cTnI水平在AMI后LVA形成患者中明显高于无LVA者,且与左心室重构程度和血流动力学变化密切相关,提示心肌坏死标记物cTnI的大量释放参与了AMI后LVA的形成过程,并影响着AMI后左心室重构和LVA的进程。
Objective To investigate the changes in cardiac troponin I（cTnI） and the relationship with the left ventricular aneurysm（LVA） and cardiac function in acute myocardial infarction（AMI） patients using left ventriculography（LVG）.Methods A total of sixty-two patients with primary anterior AMI accompanied LVA diagnosed by LVG were enrolled in this study.All patients by LVG after onset of AMI symptom were divided into LVA group（29 patients） and non-LVA group（33 patients）.Plasma cardiac troponin I was measured at 12 hours,after onset of AMI.At the immediately after PCI and 6th month after AMI,the parameters of left ventricular end diastolic volume index（LVEDVI）,left ventricular end systolic volume index（LVESVI）,left ventricular ejection fraction（LVEF）,wall motion score（WMS） and left ventricular end diastolic pressure（LVEDP） were measured by LVG.The main adverse cardiac events（MACE） were recorded in six months after PCI.Results The interval time of onset to reperfusion in LVA group was longer,and the incidence of Killip Ⅲ grade was higher than those in non-LVA group,（9.06±5.23） h vs（6.76±4.27） h（t=2.351,P〈0.05）;27.6% vs 3.0%（χ2=7.501,P〈0.01）.The peak value of plasma cTnI in LVA group was significantly higher than that in non-LVA group（158.28±15.39） pg/L vs（149.15±14.62） pg/L（t=2.212,P〈0.05）.At 6th month post-AMI,the value of LVEF,LVESVI,LVEDVI,WMS and LVEDP in non-LVA group were much better than those in LVA group（P〈0.05）.Within the six months′ follow-up,the incidence of MACE in LVA group was significantly higher than that in the non-LVA group,13 cases（44.8%） vs 4 cases（12.1%）,χ2=6.732,P〈0.01;especially it was closely correlated with the peak value of plasma cTnI（r=0.561,P〈0.05）.Conclusion The value of plasma cTnI is significantly increased and correlated closely with left ventricular remodeling status and hemodynamic change in patients with LVA after AMI.It is indicated that the over release of myocardial necrosis medium cTnI involves in the process of LVA formation and has an important clinic significance in early diagnosis and evaluation of LVA post AMI.
出处
《临床荟萃》
CAS
2010年第20期1779-1782,共4页
Clinical Focus
基金
河北省卫生厅青年课题(05164)
