CAJ | 학술논문

目的:观察急性心肌梗死患者(Acute myocardial infarction,AMI)发病10 d内、3月时自主神经功能(窦性心率震荡和心率变异性)的动态变化,冠脉血运重建治疗对自主神经功能恢复的影响,以及淋巴细胞G_(αi-2)蛋白表达的变化与自主神经功能恢复的相关性.方法:对入选的64例无严重并发症的AMI患者根据冠脉血运重建情况分为血运重建组和非血运重建组,分别在发病10d内(6～10 d),3月时两个时间段作心率,变异(Heart rate variability,HRV)和窦性心率震荡(Heart rate turbulence,HRT)分析,并检测患者淋巴细胞G_(αi-2)蛋白表达.结果:非血运重建组患者AMI 10 d内HRT指标震荡初始(Turbulence onset,T0)和震荡斜率(Turbulence slop,TS),HRV指标高功率谱(High-frequency power,HF)/总功率谱(Total-frequency power,TF)和SDNN均降低,AMI后3月这些指标均比10 d时有显著改善(P<0.05);血运重建组患者AMI 10 d内TS明显恢复,AMI后3月TO、HF/TF、SDNN值才有明显恢复.以SDNN>100 ms、TO<0、TS>2.5 ms/RR为正常参考值进行比较,两组在AMI 10 d内只有TS>2.5ms/RR有显著差异(P=0.024),AMI后3月这3个指标在两组间均无显著差异.AMI后不同时间内淋巴细胞G_(αi-2)蛋白表达的变化仅与SDNN的变化呈中等程度的正相关(r=0.448,P=O.017),与TS、TO、HF/TF等无相天性.结论:AMI后患者HRT和HRV均有动态变化现象,成功的冠脉血运重建治疗可以使反应压力感受器敏感性的HRT很快恢复,但对HRV无明显影响.G_(αi-2)蛋白表达与心脏迷走神经变化的相关性有待进一步研究证实.
목적:관찰급성심기경사환자(Acute myocardial infarction,AMI)발병10 d내、3월시자주신경공능(두성심솔진탕화심솔변이성)적동태변화,관맥혈운중건치료대자주신경공능회복적영향,이급림파세포G_(αi-2)단백표체적변화여자주신경공능회복적상관성.방법:대입선적64례무엄중병발증적AMI환자근거관맥혈운중건정황분위혈운중건조화비혈운중건조,분별재발병10d내(6～10 d),3월시량개시간단작심솔,변이(Heart rate variability,HRV)화두성심솔진탕(Heart rate turbulence,HRT)분석,병검측환자림파세포G_(αi-2)단백표체.결과:비혈운중건조환자AMI 10 d내HRT지표진탕초시(Turbulence onset,T0)화진탕사솔(Turbulence slop,TS),HRV지표고공솔보(High-frequency power,HF)/총공솔보(Total-frequency power,TF)화SDNN균강저,AMI후3월저사지표균비10 d시유현저개선(P<0.05);혈운중건조환자AMI 10 d내TS명현회복,AMI후3월TO、HF/TF、SDNN치재유명현회복.이SDNN>100 ms、TO<0、TS>2.5 ms/RR위정상삼고치진행비교,량조재AMI 10 d내지유TS>2.5ms/RR유현저차이(P=0.024),AMI후3월저3개지표재량조간균무현저차이.AMI후불동시간내림파세포G_(αi-2)단백표체적변화부여SDNN적변화정중등정도적정상관(r=0.448,P=O.017),여TS、TO、HF/TF등무상천성.결론:AMI후환자HRT화HRV균유동태변화현상,성공적관맥혈운중건치료가이사반응압력감수기민감성적HRT흔쾌회복,단대HRV무명현영향.G_(αi-2)단백표체여심장미주신경변화적상관성유대진일보연구증실.
Objective: To assess the changes of cardiac autonomic nervous function at 10 days and 3 months in patients after acute myocardial infarction (AMI) by heart rate variability (HRV) and heart rate turbulence (HRT).In parallel, we examined whether the changes in cardiac autonomic nervous function correlated with coronary revascularization and the expression of G [alpha]i2. Methods :64 postinfarction patients without severe complications were enrolled. According to whether successful reperfusion was received, they were divided into two groups (coronary revascularization group and non-coronary revascularization group). 24-hour,three-lead ambulatory electrocardiography were performed in all subjects for the analysis of HRV (SDNN and HF/TF) and HRT(TO and TS) at 10 days and three months after acute myocardial infarction.The expression of G[alpha]i2 was assessed by Western blot analysis of lymphocytes from patients at the two time points. Results:The fraction of HF/TF and SDNN increased and TO decreased at the time point of three months after AMI in both two groups compared to the time point of 10 days after AMI.TS also increased in non-coronary revascularization group but there was no significant difference between the two time points in coronary revascularization group. There were no significant differences in the parameters (SDNN>100 ms,TO<0,TS>2.5 ms/RR) at 3 months after AMI between two groups. At 10 days after AMI, there was a significant difference in TS between two groups, but there was no significant difference in the SDNN>100 ms and the TO<0. The changes of the G[alpha]i2 protein expression were only associated with the changes of SDNN(r= 0.448,P=0.017). Conclusion: There are dynamic changes of HRT and HRV in patients after AMI. The improvement of HRT after successful reperfusion might reflect rapid restoration of baroreceptor sensitivity, but there is no impact on HRV. The hypothesis that G [alpha]i2 could serve as molecular marker of cardiac vagal efferent activity could not be supported by the study .