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目的:观察螺内酯对急性心肌梗死(AMI)患者胶原代谢标志物及左室重构的影响。方法:将60例AMI患者分为常规治疗组与螺内酯治疗组,应用放射免疫法测定血浆Ⅲ型前胶原氨基末端肽(PⅢNP)、血清透明质酸(HA)含量,用超声心动图测量左室结构及舒缩功能参数。结果:常规治疗组与螺内酯治疗组AMI后第2天血浆PⅢNP分别为(5.24±1.09)、(5.14±1.21)μg/L与正常组[(5.01±1.18)μg/L]相比差异无统计学意义(均P>0.01)。螺内酯治疗组第4周、第12周血浆PⅢNP含量分别为(7.25±1.97)、(6.82±1.98)μg/L较常规治疗组同时间点含量[(10.23±2.25)、(8.36±2.11)μg/L]均显著下降(均P<0.01)。第4周、第12周螺内酯治疗组血清HA含量[(136.4±28.7)、(109.2±30.5)ng/L]与常规治疗组[(167.5±31.5)、(134.5±36.1)ng/L]比较均显著下降(P<0.01)。螺内酯治疗组第12周左室舒张期末容积指数[(57.2±5.8)ml/m2]和收缩期末容积指数[(29.2±5.3)ml/m2]与常规治疗组[(65.9±6.3),(35.7±6.8)]相比均显著降低(P<0.01);二尖瓣血流舒张早期流速(VE)与心房收缩期流速(VA)比值(VE/VA)与常规治疗组相比均显著增加(P<0.01),射血分数虽有增加,但无明显变化(P>0.05)。结论:螺内酯可降低AMI患者血浆PⅢNP、HA含量,阻抑左室重构,改善左室功能。
Objective: To observe the effect of spironolactone on collagen metabolism and left ventricular remodeling in patients with acute myocardial infarction (AMI). Methods: Sixty AMI patients were divided into routine treatment group and spironolactone treatment group. Radioimmunoassay was used to determine the content of plasma type Ⅲ procollagen aminoterminal peptide (PⅢNP) and serum hyaluronic acid (HA). The left ventricular Structure and systolic function parameters. Results: The plasma PⅢNP of the second day after AMI in the conventional treatment group and spironolactone treatment group were (5.24 ± 1.09), (5.14 ± 1.21) μg / L, respectively, compared with those in the normal group [(5.01 ± 1.18) μg / L] Significance (both P> 0.01). The levels of plasma PⅢNP in the spironolactone treatment group were (7.25 ± 1.97) and (6.82 ± 1.98) μg / L at the 4th and 12th week respectively, compared with those in the conventional treatment group at the same time points (10.23 ± 2.25 and 8.36 ± 2.11) μg / L] decreased significantly (all P <0.01). The levels of serum HA in the spironolactone treatment group at week 4 and week 12 [(136.4 ± 28.7) and (109.2 ± 30.5) ng / L] were significantly higher than those in the conventional treatment group [(167.5 ± 31.5) and (134.5 ± 36.1) ng / L] Decreased significantly (P <0.01). In the spironolactone treatment group, the end-diastolic volume index (57.2 ± 5.8) ml / m2 and systolic end volume index (29.2 ± 5.3) ml / m2 in the 12th week were significantly higher than those in the conventional treatment group [(65.9 ± 6.3), ± 6.8)] (P <0.01). The ratio of early diastolic velocity (VE) to atrial vasoconstriction velocity (VE / VA) in mitral valve was significantly higher than that in the conventional treatment group P <0.01). Although the ejection fraction increased, there was no significant change (P> 0.05). Conclusion: Spironolactone can reduce plasma PⅢNP and HA levels, restrain left ventricular remodeling and improve left ventricular function in AMI patients.