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Kokyu to Junkan Volume 46, Issue 5 （May 1998）

呼吸と循環 46巻5号（1998年5月発行）

Japanese English

研究

急性心筋梗塞におけるplasminogenactivator inhibitor−1（PAI−1）と梗塞サイズとの関係 Correlation between Plasminogen Activator Inhibitor-1 (PAI-1) and Infarct Size in Acute Myocardial Infarction 添木武 ¹ , 田村禎通 ¹ , 武市直樹 ¹ , 篠原尚典 ¹ , 由井靖子 ¹ , 福田信夫 ¹ , 須井修 ² Takeshi Soeki ¹ , Yoshiyuki Tamura ¹ , Naoki Takeichi ¹ , Hisanori Shinohara ¹ , Yasuko Yui ¹ , Nobuo Fukuda ¹ , Osamu Sui ² ¹国立善通寺病院循環器科・臨床研究部 ²国立善通寺病院放射線科 ¹Department of Cardiology, Institute for Clinical Research, Zentsuji National Hospital ²Department of Radiology, Institute for Clinical Research, Zentsuji National Hospital キーワード：急性心筋梗塞 , PAI-1 , ²⁰¹Tl心筋シンチグラフィー , acute myocardial infarction , plasminogen activator inhibitor-1 , thallium-201 myocardial imaging Keyword: 急性心筋梗塞 , PAI-1 , ²⁰¹Tl心筋シンチグラフィー , acute myocardial infarction , plasminogen activator inhibitor-1 , thallium-201 myocardial imaging pp.483-487

発行日 1998年5月15日 Published Date 1998/5/15

DOI https://doi.org/10.11477/mf.1404901692

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Abstract 文献概要
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　本研究は，AMIにおける線溶系因子の変動が梗塞サイズに及ぼす影響について検討した．対象は初回AMI患者31例で，急性期にPTCAおよび血栓溶解療法を行わなかったC群15例とPTCAを行い成功したP群16例に分けた．入院時より血漿中のt-PA, PAI−1を経時的に測定し，²⁰¹Tl心筋シンチ上の欠損サイズおよびpeak CKとの関係を検討した．その結果，①AMI発症後，PAI−1はC群では1日目は高い傾向を示し，28日目は高値であった．P群では1日目は高値を示し，7日目から28日目にかけて低下傾向であった．②t—PAはC群では1日目は高値を示し，7日目は低下し，28日目は再び上昇を認めた．P群は1日目は高値を示し，7日目から28日目にかけて低下傾向であっ．③C群およびP群の1日目のPAI−1値はそれぞれ欠損サイズと有意な正相関を認めた．④AMI発症1日目のPAI−1は，C群においてpeak CKと正相関を認めた．一方，P群においてはこの相関を認めなかった．以上より，AMI発症直後（1日目）のPAI−1値は梗塞巣の大きさを反映すると考えられた．

The purpose of this study was to clarify the effects offibrinolytic changes on infarct size in patients with acute myocardial infarction (AMI). Thirty-one patients with first AMI were divided into 2 groups: 15 patients (group C) underwent neither direct percutaneous transluminal coronary angioplasty (PTCA) nor thrombolytic therapy and 16 patients (group P) underwent successful direct PTCA. We measured serial changes in plasma level of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1). Furthermore, the rela-tionship of these factors with the size of perfusion defects in Thallium-201 myocardial imaging (extent score) and peak creatine kinase (CK) were studied. Results obtained were as follows. 1) In group C, plasma PAI- 1 levels showed a tendency to increase within 24 hours after the onset of AMI compared with the control values and remained high on the 28th day. In group P, these levels increased within 24 hours and gradually decreased from the 7th day to the 28th day, but remained high on the 28th day compared with the con-trol values. 2) In group C, plasma t-PA levels increased within 24 hours, decreased on the 7th day, and increased again on the 28th day. In group P, these levels increased within 24 hours and gradually decreased from the 7th day to the 28th day. 3) In both groups, PAI-1 levels within 24 hours correlated positively with the extent score. 4) In group C, PAI-1 levels on the 1 st day cor-related positively with the levels of peak CK on the 1st day. On the other hand, this correlations was not shown in the group P.

From these results, it is suggested that the plasma PAI -1 has the characteristics of an acute phase reactant and the PAI-1 level within 24 hours after the onset of AMI reflects the infarct size.