【摘要】：[目的]探討ST段抬高性心肌梗死(ST Segment Elevation Myocardial Infarction,STEMI)患者血運(yùn)重建前后基質(zhì)金屬蛋白酶-7(Matrix Metalloproteinase-7,MMP-7)及組織型金屬蛋白酶抑制劑-1(Tissue Inhibitor of Metalloproteinase-1,TIMP-1)血清水平的動(dòng)態(tài)變化;同時(shí)探討各時(shí)間位點(diǎn)血清MMP-7及TIMP-1濃度與左室功能及左室重塑之間的關(guān)系,為STEMI的診療提供新的思路和依據(jù)。[方法]1.選取2015年3月至2017年3月于我院心內(nèi)科行急診PCI的急性ST段抬高性心肌梗死患者38例,于PCI術(shù)前,術(shù)后24、48、72小時(shí)采集靜脈血各4ml,3000r/min離心15分鐘后,取上清,分裝于1.5毫升EP管中,置于-80℃保存,后期用液相芯片技術(shù)(liquid chip,xMAP)檢測(cè)各時(shí)間位點(diǎn)血清MMP-7及TIMP-1的濃度及其動(dòng)態(tài)變化。2.在出院前對(duì)納入的38位STEMI患者行超聲心動(dòng)圖(ultrasound cardiogram,UCG)檢查,測(cè)量左室射血分?jǐn)?shù)(LVEF),左室收縮末容積(LVESV)、左室舒張末容積(LVEDV)等指標(biāo),評(píng)估其與各時(shí)間位點(diǎn)血清MMP-7、TIMP-1濃度的關(guān)系。[結(jié)果]1.隨STEMI進(jìn)程,血清MMP-7濃度從血運(yùn)重建前(9.64±6.09ng/ml)至術(shù)后24-48h呈下降趨勢(shì)(8.81±3.35ng/ml),而在術(shù)后48-72h迅速上升至峰值(10.23±7.71ng/ml),但差異無統(tǒng)計(jì)顯著性。2.隨STEMI進(jìn)程,血清TIMP-1濃度在血運(yùn)重建前即處于波谷(116.95 ± 56.11ng/ml),而后 0-48 小時(shí)呈上升趨勢(shì)(135.18±59.57ng/ml),48-72 小時(shí)呈下降趨勢(shì)(128.29±41.93ng/ml),但差異無統(tǒng)計(jì)顯著性。3.隨STEMI進(jìn)程,MMP-7/TIMP-1比值在PCI術(shù)前達(dá)波峰,在0-48h逐漸下降達(dá)波谷,在48-72h呈上升趨勢(shì),推測(cè)MMP-7/TIMP-1比例失調(diào)可能參與急性心肌梗死的形成及心梗后的心室重塑,但差異無統(tǒng)計(jì)顯著性。4.STEMI患者血運(yùn)重建前后MMP-7、TIMP-1血清水平與LVEF、LVEDV、LVESV差異均不具統(tǒng)計(jì)學(xué)意義,均未見明顯相關(guān)性。5.STEMI患者血運(yùn)重建前后MMP-7、TIMP-1血清水平與肌鈣蛋白I之間差異不具統(tǒng)計(jì)學(xué)意義,均未見明顯相關(guān)性。6.STEMI患者血運(yùn)重建前后MMP-7、TIMP-1血清水平與GRACE評(píng)分及SYNTEX評(píng)分之間差異不具統(tǒng)計(jì)學(xué)意義,均未見明顯相關(guān)性。7.STEMI患者血運(yùn)重建前后MMP-7、TIMP-1血清水平與甘油三酯、總膽固醇、HDL及LDL之間差異均不具統(tǒng)計(jì)學(xué)意義,均未見明顯相關(guān)性。8.STEMI患者血運(yùn)重建前后MMP-7、TIMP-1血清水平與血小板計(jì)數(shù)之間無明顯統(tǒng)計(jì)差異,未見明顯相關(guān)性。[結(jié)論]1.STEMI血運(yùn)重建前后短時(shí)間(0-72h)內(nèi),MMP-7血清水平在0-48h呈下降趨勢(shì),48-72h呈上升趨勢(shì);而TIMP-1血清水平在0-48h呈上升趨勢(shì),48-72h呈下降趨勢(shì);MMP-7/TIMP-1比值在0-48h呈下降趨勢(shì),48-72h呈上升趨勢(shì);但MMP-7、TIMP-1血清水平以及MMP-7/TIMP-1比值在STEMI血運(yùn)重建前后0-72h內(nèi)無明顯統(tǒng)計(jì)學(xué)差異。2.STEMI患者血運(yùn)重建前后短時(shí)間(0-72h)內(nèi),MMP-7、TIMP-1血清水平與LVEF、LVEDV、LVESV未見明顯相關(guān)性,推測(cè)在STEMI短時(shí)間(0-72h)內(nèi),MMP-7與TIMP-1比例失調(diào)暫不能引起左室結(jié)構(gòu)和功能的變化,甚至出現(xiàn)心室重塑。
[Abstract]:[objective] to investigate matrix metalloproteinase-7 (Matrix Metalloproteinase-7,MMP-7) and tissue metalloproteinase-1 (Tissue Inhibitor of Metalloproteinase-1, in patients with ST segment elevation myocardial infarction (ST Segment Elevation Myocardial Infarction,STEMI) before and after revascularization. The dynamic changes of serum level of TIMP-1; At the same time, the relationship between serum MMP-7 and TIMP-1, left ventricular function and left ventricular remodeling at different time points was discussed, which provided a new idea and basis for the diagnosis and treatment of STEMI. [methods] 1. From March 2015 to March 2017, 38 patients with acute ST segment elevation myocardial infarction underwent emergency PCI in our hospital from March 2015 to March 2017. Venous blood samples were collected after centrifugation for 15 minutes before and 24 hours after PCI. In 1.5 ml EP tube, stored at -80 鈩，

本文編號(hào)：2349349