CAJ | 학술논문

目的：探讨缺血后处理对急性心肌梗死患者血清超氧化物歧化酶(SOD)、丙二醛(MDA)影响及临床意义。方法根据急诊经皮介入治疗术(PCI)是否设置心肌梗死后处理方式，将101例急性ST段抬高型心肌梗死患者分为缺血后处理组(46例)和常规PCI组(55例)，比较两组术后4 h、8 h、12 h、16 h、20 h、24 h、36 h和48 h血清SOD及MDA动态变化，比较两组PCI后心肌梗死溶栓(TIMI)血流、TIMI心肌灌注分级(TMPG)、血清肌酸激酶同工酶MB(CK-MB)酶峰，术后10 d核素心肌显像计分以及30 d内心脏事件的发生率。结果与常规PCI组比较，术后缺血后处理组血清SOD值明显升高(P<0.01)，MDA值明显降低(P<0.001)；SOD谷值明显增高(P<0.01)，MDA峰值显著降低(P<0.001)；TIMI血流3级和TMPG 3级患者均增多(P<0.05)；血清CK-MB峰值明显降低(P<0.01)；心肌显像计分降低(P<0.05)。术后30 d内缺血后处理组心脏事件发生率低于常规PCI组(P<0.05)。结论急性ST段抬高型心肌梗死救治中，缺血后处理能升高PCI术后血清SOD浓度，减少MDA产生，改善心肌灌注，减小梗死面积，改善患者预后。
목적：탐토결혈후처리대급성심기경사환자혈청초양화물기화매(SOD)、병이철(MDA)영향급림상의의。방법근거급진경피개입치료술(PCI)시부설치심기경사후처리방식，장101례급성ST단태고형심기경사환자분위결혈후처리조(46례)화상규PCI조(55례)，비교량조술후4 h、8 h、12 h、16 h、20 h、24 h、36 h화48 h혈청SOD급MDA동태변화，비교량조PCI후심기경사용전(TIMI)혈류、TIMI심기관주분급(TMPG)、혈청기산격매동공매MB(CK-MB)매봉，술후10 d핵소심기현상계분이급30 d내심장사건적발생솔。결과여상규PCI조비교，술후결혈후처리조혈청SOD치명현승고(P<0.01)，MDA치명현강저(P<0.001)；SOD곡치명현증고(P<0.01)，MDA봉치현저강저(P<0.001)；TIMI혈류3급화TMPG 3급환자균증다(P<0.05)；혈청CK-MB봉치명현강저(P<0.01)；심기현상계분강저(P<0.05)。술후30 d내결혈후처리조심장사건발생솔저우상규PCI조(P<0.05)。결론급성ST단태고형심기경사구치중，결혈후처리능승고PCI술후혈청SOD농도，감소MDA산생，개선심기관주，감소경사면적，개선환자예후。
Objective To explore the effect of ischemic postconditioning on serum superoxide dismutase (SOD) and malondialdehyde (MDA) in acute myocardial infarction (AMI) and clinical significance. Methods 101 AMI patients accepted emergency percutaneous coro-nary intervention (PCI) were divided into postconditioning group (n=46) and control group (n=55) according to the treatment they accepted. The concentration of serum SOD and MDA were observed 4, 8, 12, 16, 20, 24, 36, and 48 h after PCI, as well as the grade of Thrombolysis in Myocardial Infarction (TIMI) and TIMI Myocardial Perfusion Grades (TMPG), serum creatine kinase-MB (CK-MB) peak value, scoring of nuclide distribution 10 d after PCI, and frequence of cardiac events within 30 d after PCI. Results Compared with the control group, se-rum SOD increased (P<0.01) and MDA decreased (P<0.001) respectively 2, 4, 8, 12, 16, 20, 24, 36 and 48 h after the PCI, especially the val-ley of SOD and peak of MDA value in the postconditioning group;while the patient with TIMI flow of grade 3 and TMPG of grade 3 in-creased (P<0.05), the peak of serum CK-MB decreased (P<0.01), and the score of nuclide distribution decreased (P<0.05). After the opera-tion for 30 days, the frequence of cardiac events was less in the postconditioning group than in the control group (P<0.05). Conclusion Isch-emic postconditioning can reduce the peroxidation after PCI, to increase myocardial perfusion, reduce infarct area, and improve prognosis in acute ST-segment elevated myocardial infarction.