急性心肌梗死急诊PCI患者血清PⅢP浓度的变化及价值

摘要

目的 探讨急性心肌梗死(AMI)急诊PCI后血清Ⅲ型前胶原末端肽(PⅢP)浓度的变化与价值.方法 73例AMI入选患者均于入院时及AMI发病的第1、4、7天及第1、3、6个月应用放射免疫分析法测定其血清PⅢP浓度的变化.根据AMI 6个月后彩色多普勒心动超声的结果,按是否存在左室重构将其分为重构组与非重构组,并分析两组PⅢP浓度的变化与左室重构的关系.结果 AMI后左室重构患者血清PⅢP浓度持续高于非重构者,血清PⅢP浓度的峰值与6个月时LVEF、E/A之间呈负相关(r=-0.331,P<0.05;r=-0.361,P<0.05);与LVED之间呈正相关(r=0.435,P<0.01).梗死相关动脉(IRA)急诊PCI血清PⅢP峰值浓度明显低于未进行再灌注治疗[(93.4±24.1)μg/L vs(131.6±28.2)μg/L,P<0.05].结论 AMI后血清PⅢP浓度的变化是反映左室重构有用的指标,IRA再灌注可以明显减少梗死后的胶原形成,防止心肌纤维化的形成,改善左室功能.%Objective To explore the changes of procollagen Ⅲ in acute myocardial infarction after direct PCI. Methods Serum concentration of P Ⅲ P was measured by radioimmunoassay at baseline and 1, 4, 7 day and 1,3, 6 month in 73 patients after AMI. All the patients were divided into remodeling group and non-remodeling group according to their results of the sixth month echocardiography. The relationship between the sequential changes P Ⅲ P and left ventricular remodeling was analyzed. Results Serum levels of P Ⅲ P were much higher in remodeling group than those in non-remodeling group all the time. Six months after AMI, the levels of left ventricular ejection fraction (LVEF) and the ratio between peak mitral flow velocities of early and late diastole (E/A) were correlated negatively with the maximal values of P Ⅲ P (r= - 0.331 ,P＜0.05 ; r= - 0.361 , P＜0.05), and left ventricular end-diastolic diameter (LVED) were correlated positively with the maximal values of P Ⅲ P (r=0.435, P＜0.01). In patients with direct PCI,The decrease of the maximal levels of P ⅢP was found significantly in the reperfusion group than that in the non- re-perfusion group ( 93.4±24.1 vs 131.6±28.2μgL, P＜0.05 ) . Conclusion Serum level of P Ⅲ P is a useful marker reflecting the degree of left ventricular remodeling after AMI Reperfusion of the infarct related artery can reduce collagen response and myocardium fibrosis, and hence improve left ventricular function.