摘要
目的探讨尼可地尔对急性冠状动脉综合征(ACS)行冠状动脉介入(PCI)术后心绞痛患者的预后以及炎症反应的影响,为其临床应用提供参考。方法采用回顾性的病例对照研究,纳入2019年1月~2021年12月解放军总医院第六医学中心收治的230例急性冠状动脉综合征PCI术合并心绞痛患者,根据实际用药情况将其分为尼可地尔组102例及对照组128例,对其随访资料进行整理,比较两组患者的基线情况,随访4周时的临床症状、心功能指标、炎症因子水平情况,以及随访1年时的主要心血管不良事件(MACE)发生情况、不良反应、健康状况及因心绞痛再住院率情况。结果随访4周时,尼克地尔组心绞痛发作频率及持续时间较对照组下降,差异有统计学意义(t=6.25、-3.53,P<0.05)。同时,尼可地尔组B型脑利钠肽(BNP)、左室舒张末内径(LVEDD)、室间隔侧二尖瓣舒张早期血流速度峰值∕二尖瓣环舒张早期运动速度(E∕e')、侧壁侧E∕e'较对照组明显下降,差异有统计学意义(t=2.76、-3.55、2.48、4.41,P<0.05);尼可地尔组白介素-6(IL-6)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)水平较对照组明显下降,差异有统计学意义(t=-2.210、-2.054、5.280,P<0.05)。随访1年时,尼可地尔组健康状态评分高于对照组,差异有统计学意义(t=2.33,P=0.02);尼可地尔组因心绞痛再住院率低于对照组,差异有统计学意义(χ^(2)=4.87,P<0.05);尼可地尔组不良反应发生率(11.54%)与对照组(16.41%)比较,差异无统计学意义(P>0.05)。尼可地尔组患者MACE事件发生率低于对照组,差异具有统计学意义(P<0.05)。多因素logtistc回归结果提示尼可地尔为急性冠状动脉综合征行PCI术后合并心绞痛患者MACE事件发生的保护因素(P<0.05)。结论尼可地尔应用于急性冠状动脉综合征行PCI术后心绞痛患者疗效显著,能够有效缓解临床症状,改善心功能水平,减少炎症因子水平,长期应用可以降低MACE事件发生,明显改善患者的生活质量,减少心绞痛再住院率,同时也具有较高的安全性。
Objective To investigate the effect of nicorandil on the prognosis and inflammatory response of patients with angina pectoris after coronary intervention(PCI)for acute coronary syndrome,and to provide reference for clinical work.Methods A retrospective case-control study was conducted on 230 patients with acute coronary syndrome complicated with angina pectoris after PCI in the Sixth Medical Center of PLA General Hospital from January 2019 to December 2021.They were divided into the nicorandil group(102 cases)and the control group(128 cases)according to the actual medication situation.The follow-up data were carefully collated and analyzed.At the 4-week follow-up,the baseline characteristics,clinical symptoms,cardiac function indicators,and levels of inflammatory factors of the two groups were compared.At the 1-year follow-up,the occurrence of major adverse cardiovascular events(MACE),adverse reactions,health status,and the re-hospitalization rate due to angina were compared between the two groups.Results After 4 weeks of follow-up,the frequency and duration of angina pectoris in the nicorandil group decreased compared with the control group(t=6.25,-3.53;P<0.05).At the same time,the levels of B-type brain natriuretic peptide(BNP),left ventricular end-diastolic diameter(LVEDD),E/e'on the interventricular septum side,and E/e'on the lateral wall side in the nicorandil group were significantly decreased compared with the control group(t=2.76,-3.55,2.48,4.41;P<0.05).The levels of interleukin-6(IL-6),high-sensitive C-reactive protein(hs-CRP),and tumor necrosis factorα(TNF-α)in the nicorandil group were significantly decreased compared with the control group(t=-2.210,-2.054,5.280;P<0.05).At 1 year of follow-up,the health status score of the nicorandil group was higher than that of the control group(t=2.33;P=0.02),and the rate of re-hospitalization due to angina pectoris was lower than that of the control group,with statistical significance(χ^(2)=4.87;P<0.05).The incidence of adverse reactions in the nicorandil group(11.54%)and the control group(16.41%)showed no significant difference(P>0.05).The incidence of MACE events in the nicorandil group was lower than that in the control group,and the difference was statistically significant(χ^(2)=7.95;P<0.05).Multivariate logistic regression results suggested that nicorandil was a protective factor for MACE events in patients with angina pectoris after PCI(P<0.05).Conclusion The application of nicorandil in patients with angina pectoris after PCI for acute coronary syndrome is highly effective,which can effectively relieve clinical symptoms,improve cardiac function,and reduce the levels of inflammatory factors.Long-term application can reduce the occurrence of MACE events,significantly improve the quality of life of patients,reduce the rate of re-hospitalization of angina pectoris,and has high safety.
作者
向守平
杨晨
李丹丹
王锦达
Xiang Shouping;Yang Chen;Li dandan(Department of Cardiology,Xuanhan County People's Hospital,Dazhou 636150,China)
出处
《中华保健医学杂志》
2025年第1期53-57,共5页
Chinese Journal of Health Care and Medicine
基金
北京市自然基金资助项目(7222317)。
