论文部分内容阅读
目的探讨急性心肌梗死(AMI)再灌注后,有活性的成熟型肾上腺髓质素(AM)在冠状窦-主动脉差值是否有变化。方法对146例首次发生急性前壁心肌梗死患者和51例冠状动脉造影阴性作对照。入选的心肌梗死患者症状出现后24 h内完成冠状动脉腔内成形术(PICA)的再灌注治疗。再灌注后取主动脉和冠状窦血,测定血浆AM的两种分子形态(AM-m和AM-Gly)。结果AMI患者主动脉和冠状窦血浆AM-m,AM-Gly水平明显高于对照组[(1．7±1．4)pmol／L比(0．4±0．3)pmoL／L,P<0．01]。AMI患者血浆AM-m水平的冠状窦-主动脉差值明显高于对照组,而AM- Gly在两组之间差异无统计学意义(P=0．30)。AM-m的冠状窦-主动脉差值,在伴有左心室功能障碍的AMI患者(n=49)明显高于不伴有左心室功能障碍的AMI患者(n=97)。主动脉和冠状窦的血浆AM-m水平与左室射血分数呈负相关(r=-0．50,r=-0．48,P<0．01)。结论AMI再灌注后,尤其伴有严重左心室功能障碍的患者冠状动脉循环血液中AM的有活性的成熟型(AM-m)合成加速,提示AMI再通后AM经自分泌和(或)旁分泌可能对心血管起保护作用。
Objective To investigate whether active mature adrenomedullin (AM) changes in coronary sinus aorta after acute myocardial infarction (AMI) reperfusion. Methods A total of 146 patients with acute anterior myocardial infarction and 51 patients with coronary angiography were used as controls. Coronary artery endoprosthesis (PICA) reperfusion was completed within 24 h of symptom onset in the selected MI. After reperfusion, the aorta and coronary sinus blood were taken for determination of two molecular forms of plasma AM (AM-m and AM-Gly). Results The levels of AM-m and AM-Gly in the aorta and coronary sinus in patients with AMI were significantly higher than those in the control group [(1.7 ± 1.4) pmol / L vs (0.4 ± 0.3) pmoL / L, P <0.01]. AMI plasma levels of AM-m coronary sinus - aorta was significantly higher than the control group, while the AM-Gly in the two groups, the difference was not statistically significant (P = 0.30). AM-m coronary sinus-aortic differences were significantly higher in patients with AMI with left ventricular dysfunction (n = 49) than those without AMI (n = 97). Plasma AM-m levels in the aorta and coronary sinus were negatively correlated with left ventricular ejection fraction (r = -0.50, r = -0.48, P <0.01). Conclusion After AMI reperfusion, especially in patients with severe left ventricular dysfunction, the active and mature (AM-m) synthesis of AM in the coronary circulation is accelerated, suggesting that the AMI re-open after AM by autocrine and / or Secretion may have a protective effect on the cardiovascular system.