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目的 观察急性心肌梗死 (AMI)患者胶原代谢与早期左室重构的相互关系。方法 AMI患者 48例 ,根据二维超声心动图分为重构组与非重构组。应用放免法测定血浆Ш型前胶原氨基末端肽 (PⅢNP)含量 ,并与左室结构及舒缩功能参数做相关分析。结果 两组基线PⅢNP含量相似 ,AMI后患者第 4周、第 12周血浆PШNP含量分别为 (9 2 3± 3 13 ) μg/L、(6 3 3± 2 41) μg/L与第 2天 (5 2 2± 1 19) μg/L及正常对照组 (5 2 1± 1 18) μg/L比较明显升高 (P均 <0 0 1)。重构组第 4周、第 12周血浆PⅢNP含量均明显高于同时间点非重构组含量 (12 73±3 2 3 ) μg/L对 (6 53± 2 61) μg/L ;(6 49± 3 11) μg/L对 (5 49± 2 93 ) μg/L(P均 <0 0 1)。第 4周、第 12周血浆PⅢNP含量与LVESVI有良好的正相关 (r =0 40 5;r =0 513 ,P均 <0 0 1) ,与VE/VA有良好负相关 (r =-0 3 86;r=-0 3 57,P 均 <0 0 1) ,与EF有明显负相关 (r=-0 42 6;r=-0 3 4 6,P 均 <0 0 1)。结论 AMI后早期左室重构过程与心肌胶原代谢增强有关 ,血浆PⅢNP含量可作为反映重构过程的有效指标
Objective To investigate the relationship between collagen metabolism and early left ventricular remodeling in patients with acute myocardial infarction (AMI). Methods 48 patients with AMI were divided into reconstructed group and non-reconstructed group according to two-dimensional echocardiography. The radioimmunoassay was used to determine the content of plasma type III procollagen aminopeptidase (PⅢNP), and correlated with left ventricular structure and systolic and diastolic function parameters. Results The baseline PⅢNP levels were similar between the two groups. The plasma levels of PШNP at the 4th and 12th week after AMI were (9 2 3 ± 3 13) μg / L and (6 3 3 ± 2 41) μg / L and 2 days respectively (5 2 1 ± 1 19) μg / L and normal control group (5 2 1 ± 1 18) μg / L respectively (P all <0.01). Plasma PⅢNP levels in the reconstituted group at 4 weeks and 12 weeks were significantly higher than those in the non-reconstructed group (12 73 ± 3 2 3) μg / L vs 6 53 ± 2 61 μg / L 49 ± 3 11) μg / L vs (5 49 ± 2 93) μg / L (P all <0.01). There was a positive correlation between plasma PⅢNP level and LVESVI at week 4 and week 12 (r = 0 40 5; r = 0 513, P <0 01) and negative correlation with VE / VA 3 86; r = -0 3 57, P <0 01), and had a significant negative correlation with EF (r = -0 42 6; r = -0 3 4 6, P all <0.01). Conclusion The early left ventricular remodeling after myocardial infarction is associated with the enhancement of myocardial collagen metabolism. The plasma PⅢNP level can be used as an effective indicator of remodeling process