论文部分内容阅读
目的观察冠脉介入治疗术中冠脉缺血预适应对缺血修饰蛋白的影响,探讨缺血修饰蛋白改变对球囊预扩张产生缺血预处理效应的评价意义。方法随机入选60例行冠状动脉造影术的病人,分成行冠脉支架置入手术伴球囊扩张的治疗组(冠脉狭窄程度≥75%)和单纯冠脉造影的对照组(冠脉狭窄程度<75%)。治疗组术中对靶血管的病变行球囊扩张,完全阻断冠脉血流1min,分别测定第1次球囊扩张前5min与扩张后5min及支架置入后5min时的缺血修饰蛋白的水平,对照组测定术前术后的缺血修饰蛋白水平。治疗组所有病人均在连续3次持续1min球囊扩张后再置入支架。结果第1次球囊扩张前5min、球囊扩张后5min、支架置入术后5min时的IMA水平分别为77.09±13.85、90.69±23.34、82.84±21.88U/ml。支架置入术后5min时的IMA水平显著低于第1次球囊扩张后5min时(P=0.026),而支架置入术后5min时的IMA水平与第1次球囊扩张前5min时无显著差异(P=0.150);对照组造影手术前后IMA无明显改变(P=0.70)。结论一过性心肌缺血可以导致IMA水平迅速升高,但反复球囊预扩张或多次发生一过性心肌缺血会诱导缺血预适应反应,可能导致IMA水平回落,甚至恢复至基线水平。
Objective To investigate the effect of ischemic preconditioning on ischemic preconditioning in coronary interventional therapy and to evaluate the significance of the alteration of ischemic modified protein on preconditioning of ischemic preconditioning. Methods Sixty patients undergoing coronary angiography were randomly divided into two groups: coronary artery stenosis (coronary stenosis≥75%) and coronary angiography (coronary stenosis <75%). In the treatment group, balloon dilatation was performed on the target vessel during the operation, and the coronary blood flow was completely blocked for 1 min. The ischemia-modified protein 5 min before the first balloon dilatation, 5 min after the dilatation and 5 min after the stent were measured Level, the control group measured preoperative and postoperative ischemia modified protein levels. All patients in the treatment group were placed in the stent again after 3 consecutive 1-minute balloon dilations. Results The IMA levels at 5 min before balloon dilation, 5 min after balloon dilatation and 5 min after stent implantation were 77.09 ± 13.85,90.69 ± 23.34 and 82.84 ± 21.88 U / ml, respectively. The level of IMA at 5 min after stenting was significantly lower than that at 5 min after the first balloon dilation (P = 0.026), while the level of IMA at 5 min after stenting was similar to that at 5 min before balloon dilation (P = 0.150). There was no significant change of IMA in the control group before and after angiography (P = 0.70). Conclusions A transient myocardial ischemia may lead to the rapid increase of IMA level. However, repeated balloon premature dilatation or repeated myocardial ischemia may induce ischemic preconditioning reaction, which may lead to the fall of IMA level and even return to the baseline level .