急性ST段抬高心肌梗死患者血清Ⅲ型前胶原氨基端肽与心室重构的关系

摘要

目的:观察急性ST段抬高心肌梗死(STEMI)患者血清Ⅲ型前胶原氨基端肽(PⅢNP)水平与心室重构和预后的关系.方法:100例STEMI患者入选,ELISA法测定入CCU即刻和发病第7天血清中PⅢNP含量.于发病第(7±2)天和6个月时行超声心动图检查,6个月复查超声ΔLVEDVI增加≥20%为重构组,ΔLVEDVI增加<20%为非重构组.结果:第7天时,STEMI患者血清PⅢNP浓度均明显高于入院水平[(7.95±3.61)ng/ml vs (4.18±1.83)ng/ml,P<0.001],急诊PCI患者血清PⅢNP浓度明显低于未行急诊PCI者[(7.02±2.97)ng/ml vs (11.07±3.82)ng/ml,P<0.001].6个月随访时左心室重构发生率为27.96%,急诊PCI患者22.78%,未急诊干预者57.14%,两组间有显著差异P=0.008.重构组患者第7天PⅢNP浓度明显高于非重构组[(10.82±3.91)ng/ml vs (6.86±2.83)ng/ml,P<0.001].结论:STEMI患者第7天血清PⅢNP水平与半年时心室重构的发生密切相关.第7天血清PⅢNP水平升高者心室重构率高,预后差.%Objective:The aim of this study was to analyse the relation between ventricular remodeling and amino-terminal properptide of type Ⅲ procollagen in patients with ST-segment elevation myocardial infarction.Methods:100 patients with acute STEMI were evaluated.ELISA was used to determine admission and the seventh day serum PⅢNP concentration.The 7th day and the 6 the month two-dimensional echocardiograms were measured and stored at least 3 heartbeats using GE Vivid Five.LVEF and LVEDV LVESV were evaluated by the area-length method from the apical four-chamber view.Patients were divided into two gropus:the remodeling group and the group without remodeling.Results.On the 7th day the PⅢNP level of STEMI patients were significantly higher than admission[(7.95±3.61)ng/ml vs(4.18±1.83)ng/ml,P＜0.001],It's higher in patients who without PCI[(7.02±2.97)ng/ml vs(11.07±3.82)ng/ml,P＜0.001]At the 6th month month 27.96％ patients showed left ventricular remodeling.22.78％patients who received PCI encountered ventricular remodeling While 57.14％in patiens without PCI, the difference was significantly(P=0.008).The 7 th day PⅢ NP concentration was higher in patients who encountered remodeling than that of nonremodeling[(10.82±3.91)ng/ml vs(6.86±2.83)ng/ml,P＜0.001].Conclusions:The 7th day PⅢNP concentration can evaluate STEMI patients prognosis and predict remodeling.