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目的探讨急性心肌梗死(AMI)患者再灌注心律失常(RA)、心肌细胞凋亡和左室功能的关系。方法 156例经急诊再灌注治疗的 AMI 患者,分为 RA 组58例(24小时内出现 RA),非再灌注心律失常(Non-RA)组98例。应用 ELISA 方法,分别检测再灌注治疗成功后即刻、7天和2～4周血清细胞凋亡信号分子 Fas/APO-1水平,并在1周、6个月和1年做心脏彩超,检测左室射血分数(LVEF)和左室舒张末期内径(LVEDD)。结果 (1)RA 组血管开通时间较 Non-RA 组晚,且前降支病变较 Non-RA 组发生率高(P<0.05)。(2)再灌注治疗成功后即刻,RA 组血清 Fas/APO-1浓度明显高于 Non-RA 组[(13.82±4.36)μg/L 与(8.19±3.56)μg/L,P<0.05]。(3)再灌注治疗成功后第7天,两组患者血清 Fas/APO-1浓度达高峰,2～4周时明显下降,与第7天比较差异有统计学意义[RA 组(10.91±3.65)μg/L 与(14.26±4.98)μg/L,P<0.05;Non-RA 组(4.69±1.87)μg/L 与(12.19±3.25)μg/L,P<0.01],且2～4周时 RA 组 Fas/APO-1浓度明显高于 Non-RA 组[(10.91±3.65)μg/L与(4.69±1.87)μg/L,P<0.01]。(4)AMI 再灌注治疗成功后1周,RA 组与 Non-RA 组比较,LVEF 和 LVEDD 差异无统计学意义[LVEF(47.7±9.6)%与(49.2±8.9)%,P>0.05;LVEDD(59.7±10.3)mm与(57.4±12.4)mm,P>0.05]。(5)AMI 再灌注治疗成功1年后,Non-RA 组LVEF 明显高于自身急性期和 RA 组[分别为(59.5±9.2)%、(49.2±8.9)%和(49.9±10.1)%,P<0.05],LVEDD 虽然无显著性变化(P>0.05),但有增加趋势。结论心肌缺血严重患者易发生RA,且与心肌缺血所诱发心肌细胞凋亡有关,影响左室功能的恢复,促进心室重构。
Objective To investigate the relationship between reperfusion arrhythmia (RA), cardiomyocyte apoptosis and left ventricular function in patients with acute myocardial infarction (AMI). Methods A total of 156 AMI patients treated with emergency reperfusion were divided into RA group (58 cases, RA within 24 hours) and Non-RA group (98 cases). The level of Fas / APO-1 in serum was detected by ELISA at 7th, 2nd and 4th week after reperfusion. The left ventricular ejection fraction was measured at 1 week, 6 months and 1 year. Ejection ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Results (1) The vascular opening time of RA group was later than that of Non-RA group, and the incidence of anterior descending coronary artery disease was higher than that of Non-RA group (P <0.05). (2) The concentration of Fas / APO-1 in RA group was significantly higher than that in Non-RA group after reperfusion therapy ([13.82 ± 4.36] μg / L vs 8.19 ± 3.56 μg / L, P <0.05]. (3) On the 7th day after reperfusion, the serum Fas / APO-1 level in both groups peaked at 2 to 4 weeks and was significantly lower than that on the 7th day [RA group (10.91 ± 3.65 (14.66 ± 4.98) μg / L, P <0.05), while in Non-RA group (4.69 ± 1.87) μg / L and (12.19 ± 3.25) μg / L, P <0.01] The concentration of Fas / APO-1 in RA group was significantly higher than that in Non-RA group ([10.91 ± 3.65] μg / L vs (4.69 ± 1.87) μg / L, P <0.01]. (4) There was no significant difference in LVEF and LVEDD between RA group and non-RA group one week after AMI reperfusion therapy [LVEF (47.7 ± 9.6)% vs (49.2 ± 8.9)%, P> 0.05); LVEDD (59.7 ± 10.3) mm and (57.4 ± 12.4) mm respectively, P> 0.05]. (5) The LVEF of Non-RA group was significantly higher than that of its own acute group and RA group [(59.5 ± 9.2)%, (49.2 ± 8.9)% and (49.9 ± 10.1)%, respectively] P <0.05], LVEDD although no significant change (P> 0.05), but there is an increasing trend. Conclusions Patients with severe myocardial ischemia are prone to develop RA, which is related to myocardial apoptosis induced by myocardial ischemia, which may affect the recovery of left ventricular function and promote ventricular remodeling.