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目的检测急性心肌梗死(AMI)后患者的左心室(LV)功能,评估其与C反应蛋白(CRP)(早期炎症反应的标志物)之间的相关性。方法我们检测了发生AMI后患者的早期CRP水平,并将其与心脏早期结构和功能的改变相联系。从2005年11月至2011年12月,我们前瞻性地检测了514例(平均年龄(60±15)岁,59%为男性)发生AMI患者的CRP水平,并获得了超声心动图结果。测定了中位数为6.1h的早期CRP,中值CRP水平为4.8mg/L,超声心动图是发生AMI后中位数为1d的情况下测量的。结果室壁运动评分指数、左心室射血分数和左心室直径在整个CRP三分位数(所有P>0.05)范围内都非常类似。更高的CRP水平与存在中度或重度的舒张功能障碍(P=0.002)和中度或重度二尖瓣回流(P<0.001)相关。更高的CRP水平与中度或重度二尖瓣回流之间的相关性与临床特点和ST段抬高状态相独立。结论在AMI的初始阶段,CRP升高与存在严重的二尖瓣回流和舒张功能障碍有关。这表明,炎症与心室重构过程有关,而与左心室收缩功能无关。
Objective To examine left ventricular (LV) function in patients after acute myocardial infarction (AMI) and evaluate their association with C-reactive protein (CRP), a marker of early inflammatory reaction. Methods We examined patients with early CRP after AMI and correlated them with changes in early cardiac structure and function. From November 2005 to December 2011, we prospectively examined CRP levels in 514 patients (mean age 60 ± 15 years, 59% male) with AMI and obtained echocardiographic results. Early CRP was measured at a median of 6.1 h with a median CRP level of 4.8 mg / L and echocardiography measured at a median of 1 d after AMI. Results The wall motion index, left ventricular ejection fraction, and left ventricular diameter were all very similar over the entire CRP tertile (all P> 0.05). Higher CRP levels were associated with the presence of moderate or severe diastolic dysfunction (P = 0.002) and moderate or severe mitral regurgitation (P <0.001). The association between higher CRP levels and moderate or severe mitral regurgitation is independent of clinical features and ST-segment elevation. Conclusions In the initial stage of AMI, elevated CRP is associated with the presence of severe mitral regurgitation and diastolic dysfunction. This suggests that inflammation is associated with the process of ventricular remodeling but not with left ventricular systolic function.