Study On The Effect Of Shenmai Injection On The Endothelin And Ventricular Remodeling In Acute Myocardial Infarction

4Endothelin(ET), a micromolecule polypeptide and cleansinged from aorta endothelial cell of pig by Yanagisawa in 1988,is the best intensive vasoconstrictor material at present. Recent studies have shown that circulating and cardiac level of ET in acute myocardial infarction(AMI) is increased, and ET is helpful to detect the ventricular remodeling and prognosis in patients with AMI.In this experiment, we use radio immunoassay to study the dynamic changes of serum ET levels in the patients of AMI. We want to find out the effects of Shenmai injection on the level of ET and the ventricular remodeling. The effect of Shenmai injection on ventricular remodeling will be researched to provide a way to the therapy of AMI.Objective: To observe the effect of Shenmai injection on the level of serum ET and ventricular remodeling in AMI.Method: we use radio immunoassay to estimate the dynamic levels of serum ET in 40 patients receiving reperfusion by thrombolysis treatment. All the AMI cases enrolled have been divided into two groups randomly, the routine treatment group and the Shenmai treatment group. Serum are taken at the in-hospital time,2h after thrombolysis,1st,2nd,4th,7th day in patients with AMI. All the AMI cases are examed by echocardiography, Left ventricular diastolic dimension(LVDd),Left ventricular end-diastolic volume(LVEDV),Left ventricular end-systolic volume(LVESV),Fractional shortening(FS) and Ejection fraction(EF) will be recorded. The level of ET,LVDd,LVEDV,LVESV,FS and EF at different time will be compared between the two groups. All the indexes will be compared with healthy comparison group.Result:The level of serum ET is obviously higher in patients with AMI than that in healthy comparison group, and decreased obviously after treatment. There are significant differences in Shenmai treatment group. Comparied with healthy comparison group, LVEDV,LVESV and LVDd are higher ,FS and EF are lower. There are significant differences in Shenmai treatment group. Discussion:Acute myocardial infarction, which means the necrosis of myocardiym, is mainly caused by the decreased or completely loss of blood stream in the relevant coronary artery. With the development of our life,the average age of people in our country increases. The morbidity of AMI is rising. However, the mortality is decreasing because of the new therapies, such as intravenous thrombolysis and intervention, heart failure after AMI still has plagued the doctors.People in the past thought that hemodynamic abnormalities induced the development of heart failure, but the rectification of hemodynamic abnormalities can't improve the prognosis of heart failure, Latest studies demonstrate that ventricular remodeling is the molecular cytology foundation of heart failure, can influence ventricular status and prognosis of AMI.Ventricular remodeling, which is a kind of compensatory response, is a complicated pathological process. It shows compensatory hypertrophy,apoptosis,cellular necrosis,proliferation of fibroblast,accumulation of collagen protein and changes of vessel structures. In echocardiogram, it shows the accrescence of LVDd,LVEDV and LVESV and the decrease of FS and EF. The result of this experiment shows that LVEDV,LVESV and LVDd are higher than healthy comparison group ,FS and EF are lower than healthy comparison group,which proves that ventricular remodeling has happened after AMI.Many studies have proved that circulating and cardiac level of ET in AMI is increased, and ET is helpful to detect the Ventricular remodeling and prognosis in patients with AMI.Endothelin, a micromolecule polypeptide and cleansinged from aorta endothelial cell of pig by Yanagisawa in 1988,is the best intensive vasoconstrictor material at present. ET has three isom: ET-1,ET-2 and ET-3,their vasoconstrictor abilities are:ET-1>ET-2>ET- 3.Endothelin receptor(ETR ),which is a kind of G-protein-coupled receptor, is divided into three groups: ETAR,ETBR and ETCR, It's possible vasoconstrictor abilities is mediated via ETAR.We can observe from the experiment that the level of serum ET raises rapidly to the peak value on admission in patients with AMI, which is markedly higher than healthy comparison group. This result suggests that many factors can stimulate the synthesis and release of ET, for example,myocardial ischemia or damage of endotheliocyte in early stage of AMI. The level of ET decreases gradually, it is higher than healthy comparison group on 7th day, We can extrapolates that ET can act as a marker in the early diagnosis of AMI.Many studies have proved that Shenmai injection can improve coronary circulation and protect the ischemia myocardia. In this experiment,we observe the tendency of ET in the Shenmai treatment group and the routine treatment group. The result shows that the level of serum ET in two groups raise to the peak value, and decrease gradually. There is no significant difference between the two groups on 2nd day, The level of ET on 4th in Shenmai injection is significantly lower than in the routine treatment group, which indicates that Shenmai injection can decrease the level of ET in patients with AMI.In this experiment, the LVDd,LVEDV and LVESV in two groups are higher than that in healthy comparison group, while EF and FS are lower, there is no different in two groups. LVDd,LVEDV and LVESV in the fourth week are higher than in the first week in routine treatment group, they are higher than in Shenmai treatment group in fourth week. EF and FS in Shenmai treatment group of the fourth week are higher significantly than in first week and higher than in the routine treatment group. The studies indicate that Shenmai injection can decrease the advance of LVDd,LVEDV and LVESV and increase EF and FS, and confirm that Shenmai injection can increase myocardial contractility, improve ventricular remodeling after AMI.Studies demonstrate that Shenmai injection can increase myocardial contractility, in this experiment, EF in Shenmai treatmeat group is higher than routine treatment group. Many studies also prove that ET participate the ventricular remodeling.after AMI, and ET receptor antagonist can improve ventricular remodeling. We can observe from the experiment that Shenmai injection can decrease the level of AMI, and improve the development of ventricular remodeling and cardiac function in patients with AMI.Conclusion:Shenmai injection can decrease the level of serum ET in patients with AMI and improve the development of ventricular remodeling.