Ma Xiao-Jing, Zhang Xing-Hua, Luo Man, Li Chun-Mei, Shao Jian-Hua
Department of Cardiology, Shandong Provincial Hospital of Shandong University, Jinan 250021, China.
Zhonghua Yi Xue Za Zhi. 2007 Jan 9;87(2):114-7.
Postconditioning is a novel approach to myocardial protection during ischemia reperfusion. To investigate the effects of preconditioning and postconditioning on coronary blood flow velocity and prognosis of the patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI).
Ninety-six patients with AMI underwent revascularization by primary PCI within 12 h after the onset. The 35 patients with preinfarction angina were treated with preconditioning (Precond group). The other 61 patients without preinfarction angina were randomized into two groups: 29 patients undergoing PCI without postconditioning [reinfusion (IR) group], and 32 patients undergoing PCI with postconditioning (3 cycles of reinfusion for 30 s/re-occlusion for 30 s beginning within 1 minute after reinfusion, Postcond group). Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) was used to evaluate the velocity of coronary blood after PCI. Creatine phosphokinase (CK), CK-MB, and malondialdehyde (MDA) were measured before and after PCI. Wall motion score index (WMSI) was assessed by two-dimensional echocardiography before and 8 weeks after angioplasty.
There were no significant differences between the three groups with regard to age, sex, presence of angiographically visible collaterals, and elapsed time from the onset of symptoms until perfusion. The CTFC values of the patients of the Precond and Postcond groups were both 27 +/- 6, 27 +/- 6, both significantly faster than that of the patients of the IR group (31 +/- 7, both P < 0.05). The CK peak values of the Precond and Postcond groups were 1242 U/L +/- 801 U/L and 1237 U/L +/- 813 U/L respectively, both significantly lower than that of the IR group (1697 U/L +/- 966 U/L, P < 0.05). The CK-MB peak values of the Precond and Postcond groups were 122 U/L +/- 78 U/L and 117 U/L +/- 76 U/L respectively, both significantly lower than that of the IR group (172 U/L +/- 93 U/L, P < 0.05). The MDA of the Precond and Postcond groups at all time points were all significantly lower than that of the IR group (all P < 0.05). The WMSI values 8 weeks after PIC of the Precond and Postcond groups were 1.2 +/- 0.2, and 1.2 +/- 0.2 respectively, both significantly lower than that of the IR group (1.4 +/- 0.3, P < 0.05).
A simple and operative procedure to improve the coronary blood flow velocity and heart function and reduce the production of free oxygen radicals, postconditioning can be used clinically widely so as to better the prognosis of AMI.
缺血后处理是一种在缺血再灌注期间进行心肌保护的新方法。旨在研究预处理和后处理对接受急诊经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者冠状动脉血流速度及预后的影响。
96例AMI患者在发病后12小时内接受了直接PCI再灌注治疗。35例有梗死前心绞痛的患者接受预处理（预处理组）。另外61例无梗死前心绞痛的患者被随机分为两组：29例接受无后处理的PCI患者[再灌注（IR）组]，32例接受有后处理的PCI患者（再灌注后1分钟内开始进行3个周期的再灌注30秒/再闭塞30秒，后处理组）。采用校正的心肌梗死溶栓（TIMI）帧数（CTFC）评估PCI术后冠状动脉血流速度。在PCI前后测定肌酸磷酸激酶（CK）、CK-MB和丙二醛（MDA）。通过二维超声心动图在血管成形术前和术后8周评估室壁运动评分指数（WMSI）。
三组在年龄、性别、血管造影可见侧支循环的存在以及从症状发作到灌注的时间方面无显著差异。预处理组和后处理组患者的CTFC值均为27±6、27±6，均显著快于IR组患者（31±7，均P<0.05）。预处理组和后处理组的CK峰值分别为1242 U/L±801 U/L和1237 U/L±813 U/L，均显著低于IR组（1697 U/L±966 U/L，P<0.05）。预处理组和后处理组的CK-MB峰值分别为122 U/L±78 U/L和117 U/L±76 U/L，均显著低于IR组（172 U/L±93 U/L，P<0.05）。预处理组和后处理组在所有时间点的MDA均显著低于IR组（均P<0.05）。预处理组和后处理组PCI术后8周的WMSI值分别为1.2±0.2和1.2±0.2，均显著低于IR组（1.4±0.3，P<0.05）。
后处理作为一种简单且可操作的改善冠状动脉血流速度、心脏功能及减少氧自由基产生的方法，可在临床上广泛应用以改善AMI患者的预后。
