陈少敏,崔鸣,郭丽君,高炜

• 1:北京大学第三医院心内科 心血管分子生物学与调节肽卫生部重点实验室

摘要(Abstract)：

目的探讨直接经皮冠状动脉介入治疗(PCI)ST段抬高急性心肌梗死(STEMI)患者的血清血管生成素-1(Ang-1)和血管生成素-2(Ang-2)与心肌再灌注的相关性。方法连续入选103例诊断为STEMI并接受直接PCI的患者,根据术后2 h心电图ST段回落(STR)分为STR≥50%组(69例)和STR<50%组(34例)。比较两组PCI术前和术后即刻、2 h、6 h、24 h的血清Ang-1、Ang-2及Ang-2和Ang-1的比值(Ang-2/Ang-1)。用多因素Logistic回归分析心电图STR不佳的危险因素。结果 STR≥50%组术前至术后6 h Ang-1显著高于STR<50%组(P<0.05),而Ang-2/Ang-1显著低于STR<50%组(P<0.01);术后24 h Ang-1和Ang-2/Ang-1及各时间点Ang-2两组间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,术前Ang-2/Ang-1升高、发病至置入球囊时间延长、梗死相关动脉为左前降支(LAD)和术后TIMI血流<Ⅲ级是STEMI患者心电图STR不佳的独立危险因素。结论直接PCI术前Ang-2/Ang-1升高可作为STEMI患者PCI后心肌再灌注不佳的预测指标之一。

关键词(KeyWords)： 急性心肌梗死;血管生成素;心肌再灌注;ST段回落

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陈少敏,崔鸣,郭丽君,高炜

参考文献(References)：

• [1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38:675-687.
• [2]许文亮,王旭,邵一兵,等.接受直接经皮冠状动脉介入治疗的ST段抬高型急性心肌梗死患者血小板体积的变化及与冠状动脉影像的关系.中国介入心脏病学杂志,2012,20:194-198.
• [3]Niccoli G,Burzotta F,Galiuto L,et al.Myocardial no-reflow in humans.J Am Coll Cardiol,2009,54:281-292.
• [4]Tomaszuk-Kazberuk A,Kozuch M,Bachorzewska-Gajewska H,et al.Does lack of ST-segment resolution still have prognostic value6 years after an acute myocardial infarction treated with coronary intervention?Can J Cardiol,2011,27:573-580.
• [5]王红石,张大鹏,王乐丰,等.老年急性ST段抬高性心肌梗死急诊介入治疗后心肌组织水平再灌注不良的发生率及其对临床预后的影响.中国介入心脏病学杂志,2011,19:181-185.
• [6]Thomas M,Augustin HG.The role of the Angiopoietins in vascular morphogenesis.Angiogenesis,2009,12:125-137.
• [7]Chen S,Guo L,Cui M,et al.Dynamic changes in serum angiopoietin-1,angiopoietin-2,and angiopoietin-2/angiopoietin-1ratio in acute myocardial infarction patients treated with primary percutaneous coronary intervention.Biomarkers,2012,17:441-446.
• [8]Chen S,Guo L,Chen B,et al.Association of serum angiopoietin1,angiopoietin2 and angiopoietin2 to angiopoietin1 ratio with heart failure in patients with acute myocardial infarction.Exp Ther Med,2013,5:937-941.
• [9]骆莹莹,姚树桐,王大新,等.氧化应激在动脉粥样硬化发生发展中作用的研究新进展.中国介入心脏病学杂志,2013:46-50.
• [10]van der Heijden M,van Nieuw Amerongen GP,van Bezu J,et al.Opposing effects of the angiopoietins on the thrombin-induced permeability of human pulmonary microvascular endothelial cells.PLoS One,2011,6:e23448.
• [11]Ismail H,Mofarrahi M,Echavarria R,et al.Angiopoietin-1 and vascular endothelial growth factor regulation of leukocyte adhesion to endothelial cells:role of nuclear receptor-77.Arterioscler Thromb Vasc Biol,2012,32:1707-1716.
• [12]Echavarria R,Hussain SN.Regulation of angiopoietin-1/Tie-2 receptor signaling in endothelial cells by dual-specificity phosphatases 1,4 and 5.J Am Heart Assoc,2013,2:e000571.
• [13]Lee SW,Won JY,Lee HY,et al.Angiopoietin-1 protects heart against ischemia/reperfusion injury through VE-cadherin dephosphorylation and myocardiac integrin-β1/ERK/caspase-9 phosphorylation cascade.Mol Med,2011,17:1095-1106.
• [14]Galaup A,Gomez E,Souktani R,et al.Protection against myocardial infarction and no-refl ow through preservation of vascular integrity by angiopoietin-like 4.Circulation,2012,125:140-149.
• [15]Lomas-Neira J,Venet F,Chung CS,et al.Neutrophil-endothelial interactions mediate angiopoietin-2 associated pulmonary endothelial cell dysfunction in indirect acute lung injury in mice.Am J Respir Cell Mol Biol,2014,50:193-200.