摘要
目的探讨高压氧治疗冠心病不稳定型心绞痛(UAP)患者的临床疗效及其作用机制。方法选取郑州市第七人民医院2022年7月至2022年12月收治的冠心病UAP患者150例为研究对象,采用随机数字表法分为观察组和对照组,每组75例。2组患者均给予常规药物治疗,观察组患者同时应用高压氧治疗。比较2组患者的临床疗效、治疗前后临床症状、磷脂酰肌醇3-激酶(PI3K)、蛋白激酶B(AKT)、雷帕霉素靶蛋白(mTOR)mRNA相对表达量、氧化应激及炎症反应指标和血管内皮功能指标变化、治疗期间不良反应发生率。结果观察组UAP患者治疗总有效率(94.67%)明显高于对照组(82.67%),差异有统计学意义(χ^(2)=5.374,P=0.020)。与治疗前比较,2组患者治疗后心绞痛发作频率及持续时间、心肌缺血总负荷均明显下降,且观察组患者心绞痛发作频率及持续时间、心肌缺血总负荷均明显低于对照组,差异均有统计学意义(均P<0.05);2组患者治疗后PI3K、AKT、mTOR mRNA相对表达量均明显减少,且观察组患者PI3K、AKT、mTOR mRNA相对表达量(2.54±0.51、2.45±0.46、2.15±0.43)均明显低于对照组(3.26±0.54、3.02±0.50、2.68±0.45),差异均有统计学意义(均P<0.05);2组患者治疗后血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、白细胞介素(IL)-10水平均明显升高,血清丙二醛(MDA)、IL-6、肿瘤坏死因子-α(TNF-α)水平均明显降低,且观察组均比对照组明显改善,差异均有统计学意义(均P<0.05);2组患者治疗后血清一氧化氮(NO)、降钙素基因相关肽(CGRP)水平均明显升高,内皮素1(ET-1)、可溶性血管细胞黏附分子(sVCAM-1)均明显降低,且观察组均比对照组明显改善,差异均有统计学意义(均P<0.05)。观察组不良反应发生率为9.33%(7/75),对照组为14.67%(11/75),差异无统计学意义(χ^(2)=1.010,P=0.315)。结论高压氧治疗能够改善冠心病UAP患者的临床症状,提高治疗效果,可能与抑制PI3K/AKT/mTOR信号通路、拮抗氧化应激与炎症反应、调节血管内皮功能等因素有关。
Objective To investigate the clinical efficacy and mechanism of action of hyperbaric oxygen therapy in patients with unstable angina pectoris(UAP)induced by coronary heart disease.Methods A total of 150 patients with UAP induced by coronary heart disease admitted to the Seventh People’s Hospital of Zhengzhou from July 2022 to December 2022 were selected as the study subjects and randomly divided into an observation group and a control group using a random number table,with 75 cases in each group.Both groups received conventional drug therapy,while the observation group additionally underwent hyperbaric oxygen therapy.The clinical efficacy,changes in clinical symptoms before and after treatment,relative mRNA expression levels of phosphatidylinositol3-kinase(PI3K),protein kinase B(AKT),and mammalian target of rapamycin(mTOR),oxidative stress and inflammatory response indicators,vascular endothelial function indicators,and the incidence of adverse reactions during treatment were compared between the two groups.Results The total effective rate of treatment in the observation group of UAP patients(92.16%)was significantly higher than that of the control group(81.33%),with a statistically significant difference(χ^(2)=5.374,P=0.020).Compared with before treatment,the frequency and duration of angina attacks,as well as the total myocardial ischemic load,significantly decreased in both groups after treatment.Moreover,the frequency and duration of angina attacks and the total myocardial ischemic load in the observation group were significantly lower than those in the control group,and all the differences were statistically significant(all P<0.05);After treatment,the relative mRNA expression levels of PI3K,AKT,and mTOR in both groups were significantly reduced,and their relative expression levels in the observation group(2.54±0.51,2.45±0.46,2.15±0.43)were significantly lower than those in the control group(3.26±0.54,3.02±0.50,2.68±0.45),and all the differences were statistically significant(all P<0.05);After treatment,the levels of serum superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),and interleukin(IL)-10 in both groups increased significantly,while the levels of serum malondialdehyde(MDA),IL-6,and tumor necrosis factor-α(TNF-α)decreased significantly,and the observation group showed significant improvement compared with the control group;and all the differences were statistically significant(all P<0.05).After treatment,the levels of serum nitric oxide(NO)and calcitonin gene related peptide(CGRP)in both groups increased significantly,while endothelin-1(ET-1)and soluble vascular cell adhesion molecule-1(sVCAM-1)decreased significantly;the observation group showed significant improvement compared with the control group;and all the differences were statistically significant(all P<0.05).The incidence of adverse reactions was 9.33%(7/75)in the observation group and 14.67%(11/75)in the control group,with no statistically significant difference(χ^(2)=1.010,P=0.315).Conclusion Hyperbaric oxygen therapy can improve the clinical symptoms and treatment efficacy in patients with UAP induced by coronary heart disease,which may be related to the factors such as inhibiting the PI3K/AKT/mTOR signaling pathway,counteracting oxidative stress and inflammatory responses,and regulating vascular endothelial function.
作者
王地
赵育洁
胥良
杨少华
宁宏洁
刘永芳
Wang Di;Zhao Yujie;Xu Liang;Yang Shaohua;Ning Hongjie;Liu Yongfang(Department of Cardiology,The Seventh People’s Hospital of Zhengzhou,Zhengzhou 450000,China;Hyperbaric Oxygen Therapy Center,The Seventh People’s Hospital of Zhengzhou,Zhengzhou 450000,China)
出处
《中华航海医学与高气压医学杂志》
2025年第11期1180-1186,共7页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
基金
河南省医学科技公关计划项目(LHGJ20210745)。
