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目的:探讨不同PCI介入时机选择对心肌梗死患者室壁瘤逆转及MMP-9、P选择素水平的影响。方法:选取2010年3月~2016年3月收入我院的210例急性心肌梗死患者为研究对象,所有患者均经左心室合影确定合并室壁瘤。根据冠状动脉介入治疗施治时间依次分为A组(发病至PCI施治<3 h,25例)、B组(3 h≤发病至PCI施治<6 h,67例)、C组(6 h≤发病至PCI施治<12 h,88例)、D组(12 h≤发病至PCI施治≤1周,30例)。4组患者于PCI后即行导管法左心室造影,术后1周时行平衡法核素心室造影,测定患者左心室收缩、舒张功能相关参数以及反常室壁容积指数;6个月时重复上述检查;同时检测PCI治疗前后不同时间点MMP-9和P选择素水平,并随访3年,记录主要心脏事件(MACE)的发生率。结果:PCI治疗6个月后,A、B、C三组相角程及半高宽水平均显著低于D组,而左心射血分数均明显高于D组,差异有统计学意义(P<0.05);A组反常容积消失率(16/25,64%)明显高于B组(17/67,25.4%)、C组(13/88,14.8%)、D组(3/30,10.0%);组间PVI比较结果显示,A组(12.5±2.8)%、B(15.8±3.3)%、C组(15.5±3.1)%、D组(20.9±3.7)%,差异具有统计学意义(P<0.05);A组患者治疗后3 d、7 d的MMP-9和P选择素水平明显低于D组患者,差异具有统计学意义(P<0.05)。而B、C两组治疗后各时间点比较均无统计学差异,但均低于D组(P>0.05);住院期间和PCI治疗后3年随访结果显示,D组的心绞痛发生率、死亡率明显高于A、B、C三组,差异具有统计学意义(P<0.05)。结论:急性心肌梗死患者较早的接受冠脉介入干预,开通梗死动脉,能够有效逆转室壁瘤形成,同时降低机体MMP-9和P选择素水平,改善病人心功能和预后。
Objective: To investigate the effect of PCI intervention on the reversal of aneurysm and the expression of MMP-9 and P-selectin in patients with myocardial infarction. Methods: A total of 210 acute myocardial infarction patients who were admitted to our hospital from March 2010 to March 2016 were enrolled in the study. All patients were confirmed with left ventricular posterior chamber aneurysm. According to the time of coronary intervention, the patients were divided into three groups: group A (onset to PCI <3 h, 25 cases), group B (6 h to 67 h after 3 h≤PCI), group C h ≤ onset to PCI <12 h, 88 cases), group D (12 h ≤ onset to PCI ≤ 1 week, 30 cases). The left ventricular systolic and diastolic function parameters and abnormal ventricular wall volume index were measured in 4 groups after catheterization of left ventricular catheterization at 1 week after operation. The above examination was repeated at 6 months. At the same time The levels of MMP-9 and P-selectin at different time points before and after PCI were measured and followed up for 3 years. The incidence of major cardiac events (MACE) was recorded. Results: After 6 months of PCI, the phase angle and half-height width of group A, B and C were significantly lower than that of group D, while the left ventricular ejection fraction was significantly higher than that of group D (P < (16/25, 64%) in group A were significantly higher than those in group B (17/67, 25.4%), group C (13/88 and 14.8%), group D , 10.0%). Comparisons of PVI among groups showed that the differences between groups were statistically significant (12.5 ± 2.8%), B (15.8 ± 3.3)%, C (15.5 ± 3.1)% and 20.9 ± 3.7% (P <0.05). The levels of MMP-9 and P-selectin in group A at 3 d and 7 d after treatment were significantly lower than those in group D (P <0.05). However, there was no significant difference between groups B and C at all time points after treatment, but both of them were lower than those of group D (P> 0.05). The 3-year follow-up during hospitalization and PCI showed that the incidence of angina and death Rate was significantly higher than A, B, C three groups, the difference was statistically significant (P <0.05). Conclusion: The patients with acute myocardial infarction received coronary intervention earlier and the infarction artery was opened, which could effectively reverse the formation of aneurysm, reduce the levels of MMP-9 and P-selectin, and improve the cardiac function and prognosis of patients.