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目的:通过对冠心病患者经皮冠状动脉介入治疗(PCI)前后血清Caspase-3,9水平变化的观察,探讨冠状动脉介入治疗对冠心病患者血清Caspase-3,9水平的影响。方法:冠状动脉介入组(PCI组)30例和单纯造影组(CAG组)29例,在术前0.5h,术后3h,术后6h,术后12h,术后24h,术后48h分别测定血清Caspase-3,9水平。结果:CAG组术前与术后的血清Caspase-3,9水平差异均无统计学意义,PCI组术后3h、6h的Caspase-3水平较术前0.5h均有降低趋势,差异均有统计学意义(P<0.05),PCI组术后48h的Caspase-9水平与术后3h、6h相比均有升高趋势,差异均有统计学意义(P<0.05)。结论:PCI术后狭窄或闭塞的冠状动脉血管重新恢复血供,血清中Caspase-3,9水平在PCI术后先降低后又逐渐升高,提示再灌注后可出现细胞的凋亡程度加重,血清中Caspase-3,9的水平可作为心肌再灌注损伤后细胞凋亡程度的评估指标并可作为诊断临床症状不典型的再灌注损伤的一个指标。PCI术可有效改善心肌血供,减少因术前缺血缺氧造成的细胞凋亡,但PCI术后再灌注损伤可进一步加重细胞凋亡。
OBJECTIVE: To investigate the changes of serum Caspase-3 and 9 in coronary heart disease patients before and after percutaneous coronary intervention (PCI). Methods: Thirty patients in coronary artery intervention group (PCI group) and 29 patients in simple angiography group (CAG group) were measured at 0.5h before operation, 3h after operation, 6h after operation, 12h after operation, 24h after operation and 48h after operation Serum Caspase-3,9 levels. Results: There was no significant difference in serum levels of Caspase-3 and 9 before and after operation in CAG group. The levels of Caspase-3 in PCI group at 3h and 6h after operation were lower than those before 0.5h (P <0.05). The level of Caspase-9 in PCI group at 48h after operation was significantly higher than that at 3h and 6h after operation (P <0.05). Conclusion: The stenosed or occluded coronary vessels in PCI regained blood supply. The level of Caspase-3 and 9 in serum decreased first and then gradually increased after PCI, suggesting that the degree of apoptosis might be increased after reperfusion, Serum Caspase-3, 9 levels can be used as an indicator of the degree of apoptosis after myocardial reperfusion injury and can be used as an indicator of atypical clinical symptoms of reperfusion injury. PCI can effectively improve myocardial blood supply, reduce preoperative ischemia and hypoxia caused by apoptosis, but reperfusion injury after PCI can further increase cell apoptosis.