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-现代医学

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

单位：1. 昆山市第一人民医院药剂科, 江苏昆山 215300;
2. 昆山市第一人民医院心内科, 江苏昆山 215300

分类号：R541.4

出版年·卷·期（页码）：2017·36·第八期（1113-1118）

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 follow-up, 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-9 and P selectin, improve cardiac function and prognosis of patients.

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