The relationship between ST segment elevation resolution in electrocardiogram and vascular endothelial function in patients with acute myocardial infarction received direct PCI

目的:探讨急性心肌梗死(AMI)直接经皮冠状动脉介入术(PCI)后心电图ST段回落幅度与血管内皮功能的关系.方法:AMI直接PCI后梗死相关血管(IRA)血流达TIMI 3级患者51例,按ST段回落幅度分为A组32例(ST段迅速回落组)和B组19例(ST段持续抬高组).所有患者于发病(7±2)d和3个月测量肱动脉流量介导舒张(FMD)和硝酸甘油介导舒张(NMD).正常对照组25例.结果:AMI发病1周时A组和B组FMD(5.42%±2.27%与1.99%±1.63%,P＜0.05)和NMD(15.08%±8.79%与6.84%±3.92%,P＜0.05)均明显低于正常对照组(FMD9.60%±3.41%,NMD22.17%±8.49%);AMI发病后3个月A、B 2组的FMD(9.06%±1.98%与5.44%±1.91%,P＜0.01)和NMD(20.90%±5.78%与12.93%±4.71%,P＜0.01)均较基础状态增加,A组内皮功能基本恢复正常,B组虽然有恢复但未达到正常状况.结论:AMI血管内皮功能明显受损,成功再灌注后ST段持续抬高的患者受损更明显.随着时间的延长内皮功能有所恢复,ST段持续抬高的患者恢复差于ST段迅速回落者.04207-209,2172