CAJ | 학술논문

目的观察冠状动脉介入治疗(PCI)患者梗死心肌质量、左室射血分数(LVEF)和室壁运动异常评分,分析相关因子与左室功能的相关性.方法选择急性心肌梗死患者43例,利用磁共振延迟成像分为透壁增强组、非透壁增强组和混合组.于PCI术前及术后6个月检测各组患者血清内皮素(ET)、基质金属蛋白酶9(MMP-9)和高敏C反应蛋白(hsCRP),分析计算各组梗死心肌质量、左室射血分数(LVEF)和室壁运动异常评分.结果非透壁增强组及混合组患者PCI术后比术前梗死心肌质量[分别为(4.0 ±2.9)g/cm3比(9.8±5.6)g/cm3,(6.0±3.5) g/cm3比(11.8 ±6.2)g/cm3]及LVEF[分别为(52.6±15.4)％比(41.9±16.3)％,(45.6±15.4)％比(38.9±16.3)％]均有改善(P＜0.05).PCI术前及术后LVEF与梗死心肌质量独立相关(RR分别为0.318及0.293,P＜0.05),术前LVEF尚与hsCRP水平独立相关(RR为0.318,P＜0.05).结论不同心肌梗死程度的患者PCI术后心功能改善情况不同；其改善情况与存活心肌的数量及炎性因子相关.
목적 관찰관상동맥개입치료(PCI)환자경사심기질량、좌실사혈분수(LVEF)화실벽운동이상평분,분석상관인자여좌실공능적상관성.방법 선택급성심기경사환자43례,이용자공진연지성상분위투벽증강조、비투벽증강조화혼합조.우PCI술전급술후6개월검측각조환자혈청내피소(ET)、기질금속단백매9(MMP-9)화고민C반응단백(hsCRP),분석계산각조경사심기질량、좌실사혈분수(LVEF)화실벽운동이상평분.결과 비투벽증강조급혼합조환자PCI술후비술전경사심기질량[분별위(4.0 ±2.9)g/cm3비(9.8±5.6)g/cm3,(6.0±3.5) g/cm3비(11.8 ±6.2)g/cm3]급LVEF[분별위(52.6±15.4)％비(41.9±16.3)％,(45.6±15.4)％비(38.9±16.3)％]균유개선(P＜0.05).PCI술전급술후LVEF여경사심기질량독립상관(RR분별위0.318급0.293,P＜0.05),술전LVEF상여hsCRP수평독립상관(RR위0.318,P＜0.05).결론 불동심기경사정도적환자PCI술후심공능개선정황불동；기개선정황여존활심기적수량급염성인자상관.
Objective To evaluate the effect of percutaneous coronary intervention (PCI) on left ventricular function in patients with different types of myocardial infarction and to explore the correlation factors for the left ventricular function.Methods A total of 43 patients diagnosed as acute myocardial iffarction were enrolled in this study.The perfusion and delayed enhancement magnetic resonance imaging (DE-MRI) was applied to observe the following parameters before the PCI and at month 6 after the procedure:infarct mass,left ventricular ejection fraction (LVEF) and abnormal wall motion score.The subjects were divided into the following three groups by the transmural extent of myocardial infarction manifested in the DE-MRI:the transmural enhancement group,the nontransmural group and the mixed group.Laboratory test was done to detect the level of endothelin (ET),matrix metal enzyme 9 (MMP-9) and high sensitive C reactive protein (hsCRP) before PCI and at month 6 after the procedure.The t test was used to compare the differences among the groups and the multiple regression analysis was taken to explore the correlation factors for the left ventricular function.Results Compared with the parameters before PCI,the infarct mass after PCI significantly decreased in the nontransmural group and the mixed group [(4.0 ± 2.9) g/cm3 vs (9.8 ±5.6) g/cm3 and (6.0 ±3.5) g/cm3 vs (11.8 ±6.2) g/cm3,all P ＜0.05],while LVEF was significantly improved after PCI in both groups [(52.6 ± 15.4) ％ vs (41.9 ± 16.3) ％,(45.6 ± 15.4)％ vs (38.9 ± 16.3)％,all P ＜0.05].The infarct mass was an independent correlation factor for LVEF before PCI (RR =0.318,P ＜0.05) and LVEF after PCI(RR =0.293,P ＜0.05).LVEF before PCI was independently correlated with the level of hsCRP (RR =0.318,P ＜ 0.05).Conclusion The effect of PCI on the improvement of left ventricular function differs in patients with different extent of myocardial infarction,which is correlated with the amount of survival myocardium and the inflammatory factors.