急性心肌梗死后心肌微循环障碍与炎症反应的关系

摘要

目的 通过心肌超声造影技术(MCE)观察急性心肌梗死(AMI)后心肌微循环障碍是否与炎症反应有关.方法 入选患者81例(AMI组),发病24 h内采集静脉血检测白细胞计数(WBC)、超敏C反应蛋白(hsCRP)、中性粒细胞百分比(G%).根据WBC高低将AMI组分为A组(40例,WBC≥10×109/L)及B组(41例,WBC＜10×109/L).30例健康者为对照组.入院5～7 d AMI组及对照组进行MCE检查,检测各节段心肌造影剂强度(A)、心肌血流速率(β)、心肌血容量(MBF).结果 与正常组比较,A组WBC、hsCRP和B组hsCRP显著升高(P＜0.05);A组MCE各指标显著低于B组(P＜0.05);A组WBC、hsCRP与β值之间呈显著负相关(BWBC=-0.67,P＜0.05;BhscRP=-0.51,P＜0.05).结论 AMI后炎症指标明显增高;炎症指标愈高,微循环灌注愈差.%Objective To investigate the correlation between myocardial microcirculation and inflammation in acute myocardial infarction(AMI)by myocardial contrast echocardiography(MCE).Methods Eighty-one AMI patients(AMI group)and 30 healthy adults(normal control group)were enrolled.White blood cell(WBC),hypersensitive C reactive protein(hsCRP)and neutrophilic gtanulocyte percentage(G%)were measured in patients and healthy adults.According to different count of WBC,AMI group was devided into A group(n=40,WBC≥10×109/L)and B group(n=41,WBC＜10×109/L).Myocardial contrast intensity(A),blood flow rate(β)and myocardial blood volume(MBF=A×β)of each segment were measured by MCE during 5-7 days of hospitalization.Results Compared with control group.WBC,hsCRP in A group and hsCRP in B group were significantly elevated(P＜0.05).A,β and MBF in A group were significantly lower than those in B group(P＜0.05).WBC and hsCRP in A group had significant negative correlations with β respectively(BWBC=-0.67,P＜0.05;BhsCRP=-0.5 1,P＜0.05).Conclusions The level of plasma inflammatory factors were remarkably increased after AMI,which had a positive correlation with low microcirculation perfusion.