摘要
目的探讨前列地尔对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)后的心肌缺血再灌注、血清炎症因子、氧化应激和血管内皮功能的影响。方法选取STEMI患者106例,随机分为对照组和病例组各53例。对照组给予PCI常规治疗,病例组给予PCI和前列地尔治疗。观察两组PCI前后的心肌梗死溶栓治疗(TIMI)分级、有无复流现象(NRP)现象,左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD),PCI术后24 h肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和肌钙蛋白(cTn)I,TIMI分级、TIMI帧数计数(CTFC)、心肌显影密度分级(MBG)、PCI术后2 h ST段回落≥50%情况,白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP),超氧化物歧化酶(SOD)水平、丙二醛(MDA)和血清内皮素(ET)-1、一氧化氮(NO)水平及两组PCI术后住院期间主要不良事件(MACE)发生情况。结果PCI后,病例组TIMI血流分级、TIMI3级、MBG3级、术后2 h ST段回落≥50%发生率高于对照组,NRP发生率低于对照组(P<0.05)。两组MACE发生率无明显差异(P>0.005)。两组PCI后LVEF、SOD、NO较PCI前升高,LVESD、CK-MB、LDH、cTnI、IL-6、IL-8、TNF-α、CRP、MDA、ET-1较PCI前降低(P<0.05);病例组心功能、心肌酶指标、血清炎症指标、氧化应激和血管内皮功指标改善情况优于对照组(P<0.05)。结论前列地尔联合PCI术对于急性ST段抬高型心肌梗死患者可以显著改善心肌再灌,降低炎症反应程度,保护心肌细胞,改善心功能,调节氧化应激水平,降低术后MACE发生风险。
Objective To investigate the effects of alprostadil on myocardial ischemia-reperfusion,serum inflammatory factors,oxidative stress and vascular endothelial function after percutaneous coronary intervention(PCI)in patients with ST-segment elevation acute myocardial infarction.Methods A total of 106 patients with ST-segment elevation acute myocardial infarction who were hospitalized in Xingtai People's Hospital from January 2019 to December 2019 were selected as the research subjects.According to the random number table method,the patients were divided into control group and case group with 53 cases each.The control group was given PCI routine treatment,and the case group was given PCI and alprostadil treatment.Before and after PCI,myocardial infarction thrombolytic therapy(TIMI)grade,with or without reflow(NRP),left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular diastole end-diameter(LVEDD),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),and troponin(cTn)I 24 hours after PCI density grading(MBG),ST segment fall≥50%2 h after PCI,interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-αand C-reactive protein(CRP),levels of superoxide dismutase(SOD),malondialdehyde(MDA)and serum endothelin(ET)-1,nitric oxide(NO),and major adverse events(MACE)during postoperative PCI were observed in two groups.Results After PCI,the incidence of TIMI blood flow classification,TIMI3,MBG3,and ST segment fall≥50%at 2 h after operation was higher in the case group than that in the control group,and the incidence of NRP was lower than that in the control group.The incidence rate of MACE in the case group was 9.43%,which was lower than that of control group(20.75%),and the difference was statistically significant(χ2=5.592,P=0.018).Aftre PCI,LVEF,SOD,and NO in the two groups of patients were higher than those before PCI,while LVESD,CK-MB,LDH,cTnI,IL-6,IL-8,TNF-α,CRP,MDA,and ET-1 were lower than those before PCI.The differences between the groups were statistically significant(all P<0.05);the improvement of cardiac function,myocardial enzyme indexes,serum inflammation indexes,oxidative stress and vascular endothelial function indexes in the case group were better than those of control group,and the differences were statistically significant(all P<0.05).Conclusions Alprostadil combined with PCI could significantly improve myocardial reperfusion,reduce the degree of inflammatory response,protect myocardial cells,improve cardiac function,regulate oxidative stress,and reduce the risk of postoperative MACE in patients with ST-segment elevation acute myocardial infarction.
作者
林书坡
郑艳秋
郑春贵
韩毅
胡波
LIN Shu-Po;ZHENG Yan-Qiu;ZHENG Chun-Gui(Department of Cardiology,Xingtai People's Hospital,Xingtai 054000,Hebei,China)
出处
《中国老年学杂志》
CAS
北大核心
2020年第24期5153-5156,共4页
Chinese Journal of Gerontology
基金
国家自然科学基金项目(81400260,81400326)。
关键词
前列地尔
急性ST段抬高型心肌梗死
经皮冠状动脉介入
心肌缺血再灌注
Alprostadil
ST-segment elevation acute myocardial infarction
Percutaneous coronary intervention
Cardiac ischemic reperfusion
