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目的 :观察急性冠脉缺血综合征 (ACIS)几种血浆介质的变化及意义。方法 :6 5例 ACIS患者被分为 AMI组(4 3例 ) ,不稳定型心绞痛组 (2 2例 ) ,于其发病后 12、 14、 48小时和 2 0天检查血肌酸激酶同工酶 (CK- MB)、内皮素 (ET)、β内啡肽 (β- EP)水平。结果 :ET峰值 :AMI组、心绞痛组分别为发病 12小时的 2 88.4± 80 .6 pg/ml,2 45 .1± 6 3.4pg/ml;β- EP峰值 :AMI组为 2 4小时的 2 10 .9± 5 0 .2 pg/ml,心绞痛组为 12小时的 15 4.2± 47.6 pg/ml;CK-MB>15 0 U/L 组 :β- EP2 40 .5± 42 .6 pg/ml,ET30 2 .4± 5 8.1pg/ml,明显高于 CK- MB<10 0 U/L组的 (P<0 .0 5 )。心功能 级患者 :β- EP 2 48.6± 2 7.3pg/m l,ET 311.6± 45 .2 pg/ml,明显高于心功能正常组 (P<0 .0 5 )。结论 :(1) ACIS发病后 β- EP在 2 4小时达到峰值 ,升高程度与心肌缺血坏死程度有关 ,它是 AMI后心衰的病理性介质之一 ;(2 ) ACIS发病后 ET迅速升高 ,12小时达到峰值 ,是急性损伤时的一种内源性致病因子 ,能诱发冠状动脉痉挛和血小板聚集。
Objective: To observe the changes and significance of several plasma mediators in acute coronary syndrome (ACIS). Methods: Totally 65 ACIS patients were divided into AMI group (43 cases) and unstable angina pectoris group (22 cases). Blood creatine kinase was detected at 12, 14, 48 hours and 20 days after onset Enzyme (CK-MB), endothelin (ET), β-endorphin (β-EP) levels. Results: The peak value of ET: AMI group and angina pectoris group were 88.4 ± 80.6 pg / ml and 245.1 ± 6.3 pg / ml for 12 hours of onset, respectively; β-EP peak value was 24 hours for AMI group 10 .9 ± 50.2 pg / ml for angina pectoris group, 15 4.2 ± 47.6 pg / ml for angina pectoris group for 12 hours and CK-MB> 150 U / L group for β-EP2 40.5 ± 42.6 pg / ml , ET30 2 .4 ± 5 8.1pg / ml were significantly higher than CK-MB <10 0U / L group (P <0.05). Cardiac function patients: β-EP2 48.6 ± 2 7.3pg / ml, ET 311.6 ± 45.2 pg / ml, was significantly higher than the normal cardiac function group (P <0.05). Conclusion: (1) β-EP reached the peak at 24 hours after onset of ACIS, which is related to the degree of myocardial ischemia and necrosis. It is one of the pathological mediators of heart failure after AMI. (2) ET rapidly after ACIS onset Rise, peaked at 12 hours and is an endogenous causative agent of acute injury that can induce coronary spasm and platelet aggregation.