ST段抬高型心肌梗死患者及时再灌注后炎症反应迟钝。

Blunted inflammatory response in STEMI patients timely reperfused.

机构信息

Cardiology Department, University of Foggia, Foggia, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2014 Jan;15(1):48-52. doi: 10.2459/JCM.0b013e328365c13a.

DOI:10.2459/JCM.0b013e328365c13a

PMID:24492356

Abstract

BACKGROUND

Acute coronary syndrome is characterized by an acute inflammatory systemic response. We investigated whether timely reperfusion could reduce the inflammatory response in patients with ST-elevation acute myocardial infarction (STEMI).

METHODS

Forty-seven consecutive patients with STEMI eligible for fibrinolysis and admitted to a coronary care unit were enrolled in the study and reperfused with tenecteplase; 33 patients admitted 6 h after the onset of chest pain (late comers), who therefore underwent delayed coronary angioplasty, acted as controls. All patients underwent serial blood sampling in order to evaluate plasma concentrations of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) for 4 days. Patients treated with primary (<6 h from symptom onset) or rescue angioplasty were excluded from the study.

RESULTS

CRP, ESR and fibrinogen in patients who were timely reperfused showed significantly lower values compared to late comer controls (P < 0.05). In a multivariable analysis considering age, sex, diabetes, presence of anterior wall infarction, presence of Q-waves, left-ventricular ejection fraction and peak troponin levels, timely reperfusion was inversely related to CRP peak values (hazard ratio 0.74, 95% confidence interval 0.55-0.98, P < 0.05).

CONCLUSION

Timely reperfusion can blunt inflammatory activation in patients with STEMI.

摘要

背景

急性冠状动脉综合征的特征是急性炎症全身反应。我们研究了及时再灌注是否可以减少 ST 段抬高型急性心肌梗死（STEMI）患者的炎症反应。

方法

本研究纳入了 47 例适合溶栓且入住冠心病监护病房的 STEMI 患者，给予替奈普酶溶栓治疗；其中 33 例胸痛发作 6 小时后入院（晚期就诊者），行延迟冠状动脉成形术，作为对照组。所有患者连续采血 4 天，以评估血浆 C 反应蛋白（CRP）、纤维蛋白原和红细胞沉降率（ESR）浓度。未接受直接或补救性经皮冠状动脉介入治疗的患者被排除在研究之外。