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目的:联合抽吸导管局部(罪犯血管)取样,评价急性ST段抬高心肌梗死(STEMI)时全身(主动脉根部)与局部血浆组织蛋白酶抑制素(LL-37)水平的变化。方法:连续入选我院履行知情同意且接受冠状动脉造影(冠造)的男性患者122例,无动脉粥样硬化性冠心病(无CAD)组31例、稳定CAD组44例、STEMI组47例。STEMI组接受急诊冠状动脉介入治疗(PCI)和血栓抽吸。全身血样经造影导管取自主动脉根部,局部血样(STEMI组)经抽吸导管取自罪犯血管。STEMI组的最后6例患者在冠状动脉介入治疗术前、冠状动脉介入治疗术后即刻和发病第1、3、5天采集外周静脉血。夹心酶联免疫吸附法(ELISA)测定血浆LL-37水平。结果:STEMI组全身血浆LL-37水平较无CAD组、稳定CAD组降低,差异有统计学意义(P=0.001～0.009)。STEMI组局部血浆LL-37水平高于全身,差异有统计学意义(P=0.013)。多时间点取样观察STEMI组6例患者全身血浆LL-37水平变化:发病第1天、第3天、第5天比冠状动脉介入治疗术前及术后即刻均升高(P=0.000～0.002)。结论:STEMI患者全身血浆LL-37水平下降并在发病1天后升高,而STEMI时闭塞罪犯血管局部血浆LL-37水平高于其全身,提示LL-37可能在STEMI发病中起着重要作用。
OBJECTIVE: To assess the changes of systemic (aortic root) and local plasma cathepsin (LL-37) levels in patients with acute ST-segment elevation myocardial infarction (STEMI) by sampling the local (culprit vessel) aspiration catheter. Methods: A total of 122 consecutive male patients with informed consent and coronary angiography (coronary artery disease) underwent coronary artery angiography (CAD) in our hospital, 31 patients without coronary atherosclerotic coronary heart disease (CAD), 44 with stable CAD, 47 with STEMI . The STEMI group underwent emergency PCI and thrombus aspiration. Whole body blood samples were taken from the aortic root through a contrast catheter, and local blood samples (STEMI group) were taken from the culprit vessel via a suction catheter. The last 6 patients in the STEMI group received peripheral venous blood immediately prior to PCI and prior to PCI and on days 1, 3 and 5 of onset. The level of plasma LL-37 was measured by sandwich enzyme-linked immunosorbent assay (ELISA). Results: Compared with non-CAD group and stable CAD group, LL-37 level in STEMI group was significantly lower (P = 0.001-0.009). The level of plasma LL-37 in STEMI group was higher than that in the whole body, the difference was statistically significant (P = 0.013). The changes of systemic plasma LL-37 levels in 6 cases of STEMI group were observed at multiple time points: the incidences of LL-37 on the 1st, 3rd and 5th day after PCI were significantly higher than those before PCI and immediately after the PCI (P = 0.000-0.002 ). CONCLUSIONS: The level of LL-37 decreased in systemic STEMI patients and increased one day after STEMI. However, the level of LL-37 in local blood plasma of STEMI patients was higher than that of whole body, suggesting that LL-37 may play an important role in the pathogenesis of STEMI.