2019 年第 12 期 第 14 卷

尼可地尔在行经皮冠状动脉介入治疗的急性心肌梗死患者中的作用研究

Therapeutic effect of nicorandil on patients with acute myocardial infarction undergoing percutaneous coronary intervention

作者：崔晓燕王圣岑运光王太昊田徐露

英文作者：

单位：570311海口，海南省人民医院医疗保健中心（崔晓燕、岑运光、王太昊、田徐露），心内科（王圣）

英文单位：

关键词：急性心肌梗死；尼可地尔；胱抑素C；炎症因子

英文关键词：

• 摘要：

• 【摘要】目的    探讨尼可地尔对急性心肌梗死患者经皮冠状动脉介入（PCI）治疗后左心室功能、血清胱抑素C和炎症因子水平的影响。方法    选取2017年2月至2018年8月海南省人民医院收治的急性心肌梗死患者89例，按随机数字表法分为观察组（45例）与对照组（44例），对照组接受常规药物治疗;观察组在对照组治疗基础上于确诊后即开始口服尼可地尔片治疗，连续服用1个月。比较2组PCI术后1周及1个月左心室功能指标、心肌酶指标、血清胱抑素C和炎症因子水平。结果    术后1周，2组患者左心室功能指标、心肌酶指标、血清胱抑素C和炎症因子水平比较差异均无统计学意义（均P>0.05）。术后1个月，观察组左心室射血分数和心脏指数高于对照组［(53.1±3.4)%比（47.7±3.4）%、(2.83±0.54)L/（min·m2）比（2.52±0.47）L/（min·m2）］，左心室舒张末期容积指数、左心室收缩末期容积指数低于对照组［(91±12)ml/m2比（104±13）ml/m2、(48±6)ml/m2比（52±8）ml/m2］，差异均有统计学意义（均P＜0.05）。术后1个月，2组血浆肌酸激酶和乳酸脱氢酶水平均低于术后1周，且观察组低于对照组［(57±6)kU/L比（65±7）kU/L、(5 815±472)U/L比（6 357±522）U/L］，差异均有统计学意义（均P＜0.05）。术后1个月，2组患者血清胱抑素C以及肿瘤坏死因子α、白细胞介素17水平均低于术后1周，且观察组低于对照组［(2.12±0.26)mg/L比（3.53±0.44）mg/L、(107±35)ng/L比（128±49）ng/L、（280±34）μg/L比（302±35）μg/L］，白细胞介素10均高于术后1周、且观察组高于对照组［(18.9±2.2)μg/L比（16.8±4.3）μg/L］，差异均有统计学意义（均P＜0.05）。结论    尼可地尔可有效增强急性心肌梗死患者PCI术后的心肌功能，降低血浆肌酸激酶和乳酸脱氢酶含量，改善血清胱抑素C及炎症因子水平。

• 【Abstract】Objective    To investigate the effect of nicorandil on left ventricular function, serum cystatin C and inflammatory factors in patients with acute myocardial infarction undergoing percutaneous coronary intervention（PCI）. Methods    A total of 89 patients with acute myocardial infarction admitted to Hainan General Hospital from February 2017 to August 2018 were randomly divided into observation group（45 patients） and control group（44 patients）. The control group was treated with conventional drugs and the observation group took nicorandil additionally for 1 month. Left ventricular function and myocardial enzyme indexes, serum levels of cystatin C and inflammatory factors were detected 1 week and 1 month after PCI. Results    There were no statistical differences in left ventricular function, myocardial enzymes, serum cystatin C and inflammatory factors between groups at 1 week after PCI. One month after PCI, left ventricular ejection fraction and cardiac index in the observation group were significantly higher and left ventricular end-diastolic and end-systolic volume indexes were significantly lower than those in the control group［(53.1±3.4)% vs (47.7±3.4)%, (2.83±0.54)L/(min·m2) vs (2.52 ±0.47)L/(min·m2), (91±12)ml/m2 vs (104±13)ml/m2, (48±6)ml/m2 vs (52±8)ml/m2］（all P＜0.05）. Plasma levels of creatine kinase and lactate dehydrogenase decreased at 1 month as compared with 1 week after operation, and the levels in the observation group were significantly lower than those in the control group［(57±6)kU/L vs (65±7)kU/L, (5 815±472)U/L vs (6 357±522)U/L］(all P<0.05). Levels of serum cystatin C, tumor necrosis factor-α and interleukin-17 decreased at 1 month as compared with 1 week after operation and they were lower in the observation group than those in the control group［(2.12±0.26)mg/L vs （3.53±0.44）mg/L, (107±35)ng/L vs （128±49）ng/L, （280±34）μg/L vs （302±35）μg/L］; serum interleukin-10 level increased at 1 month after operation and it was higher in the observation group than that in the control group［(18.9±2.2)μg/L vs （16.8±4.3）μg/L］（all P＜0.05）. Conclusion    Nicorandil can effectively enhance myocardial function, reduce plasma creatine kinase and lactate dehydrogenase, improve serum cystatin C and inflammatory factors after PCI for acute myocardial infarction.