2019 年第 3 期 第 14 卷

替格瑞洛联合重组人脑利钠肽对急性心肌梗死患者经皮冠状动脉介入术后微循环改善及心肌损伤标志物的影响

Effect of ticagrelor combined with recombinant human brain natriuretic peptide on microcirculation improvement and myocardial injury markers in patients with acute myocardial infarction after percutaneous coronary intervention

作者：刘虹宏刘兆川张誉籍张冬花张京梅李志忠

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科十五病房（刘虹宏、张冬花、张京梅、李志忠）；071000河北省保定市，陆军第82集团军医院心内科（刘兆川）；110016沈阳，沈阳军区总医院心内科（张誉籍）

英文单位：

关键词：急性心肌梗死；替格瑞洛；重组人脑利钠肽；微循环；心肌损伤标志物

英文关键词：

• 摘要：

• 【摘要】目的    观察联合使用替格瑞洛和重组人脑利钠肽对急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后微循环及心肌损伤标志物的影响。方法    收集2017年1—12月首都医科大学附属北京安贞医院因AMI行PCI术后165例患者的临床资料。根据用药的不同分为A组（单独使用替格瑞洛），B组（单独使用重组人脑利钠肽）及C组（联合使用替格瑞洛和重组人脑利钠肽），每组55例。比较3组患者肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、左心室质量指数（LVMI）及心肌梗死溶栓试验心肌灌注分级（TMPG）。结果    与治疗前比较，3组患者治疗后CK-MB、cTnI、LVEDD及LVMI均降低，LVEF升高，差异均有统计学意义（均P<0.05）。治疗后，A组与B组间CK-MB、cTnI、LVEDD、LVEF及LVMI差异均无统计学意义（均P>0.05）；治疗后，C组CK-MB、cTnI、LVEDD及LVMI低于A组和B组，LVEF高于A组和B组［（95±11）U/L比（113±15）、（112±13）U/L，（0.53±0.05）μg/L比（0.72±0.09）、（0.68±0.08）μg/L，（55.0±1.6）mm比（57.9±1.7）、（57.2±1.8）mm，（132±6）比（136±7）、（136±7），（56±4）%比（53±4）%、（53±3）%］，差异均有统计学意义（均P<0.05）。3组患者术后TMPG结果显示，C组患者在0～1级和2～3级的分布情况（0～1级3例、2～3级52例）与A组（0～1级12例、2～3级43例）和B组（0～1级10例、2～3级45例）间差异有统计学意义（χ2=6.317，P=0.042; χ2=6.153，P=0.044）；但A组和B组差异无统计学意义（P>0.05）。结论    联合使用替格瑞洛和重组人脑利钠肽能够显著改善AMI患者行PCI术后微循环情况，降低血清心肌损伤标志物水平，改善心功能，对于AMI患者行PCI术后的预后改善具有积极的意义和临床价值。

• 【Abstract】Objective    To observe the effect of combined use of ticagrelor and recombinant human brain natriuretic peptide on microcirculation improvement and myocardial injury markers in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI). Methods    Clinical data of 165 AMI patients who underwent PCI in Beijing Anzhen Hospital, Capital Medical University from January to December 2017 were retrospectively analyzed. They were divided into group A(treated with ticagrelor, n＝55), group B(treated with recombinant human brain natriuretic peptide, n＝55) and group C(treated with ticagrelor and recombinant human brain natriuretic peptide, n＝55). Creatine kinase isozyme(CK-MB), cardiac troponin I(cTnI), left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), left ventricular mass index(LVMI) and thrombolysis in myocardial infarction perfusion grading(TMPG) were analyzed. Results    After treatment, CK-MB, cTnI, LVEDD, LVMI significantly decreased and LVEF significantly increased in all the three groups(all P<0.05). There was no significant difference of them between group A and B(all P>0.05); CK-MB, cTnI, LVEDD and LVMI in group C were significantly lower and LVEF was significantly higher than those in group A and B［（95±11）U/L vs （113±15）,（112±13）U/L; （0.53±0.05）μg/L vs （0.72±0.09）,（0.68±0.08）μg/L; （55.0±1.6）mm vs （57.9±1.7）,（57.2±1.8）mm; （132±6） vs （136±7）,（136±7）; （56±4）% vs （53±4）%,（53±3）%］(all P<0.05). There were significant differences of TMPG 0-1 and 2-3 of group C(3 cases of grade 0-1 and 52 cases of grade 2-3) compared to those in group A(12 cases of grade 0-1 and 43 cases of grade 2-3) and group B(10 cases of grade 0-1 and 45 cases of grade 2-3)(χ2=6.317， P=0.042; χ2=6.153，P=0.044); but no marked difference was noticed between group A and B(P>0.05). Conclusion    Combined use of ticagrelor and recombinant human brain natriuretic peptide can significantly improve microcirculation after PCI in patients with AMI, reduce serum myocardial injury markers, improve cardiac function and the prognosis.