2020 年第 1 期 第 15 卷

替罗非班联合尼可地尔对ST段抬高型心肌梗死急诊经皮冠状动脉介入患者炎性反应和心功能的影响

Effect of tirofiban combined with nicorandil treating acute ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention on inflammatory response and cardiac function

作者：刘春丽梁延宏薛恩忠贺继忠

英文作者：

单位：陕西省延安市人民医院心血管内科716000

英文单位：

关键词：ST段抬高型心肌梗死；替罗非班；尼可地尔；经皮冠状动脉介入；炎症因子

英文关键词：

• 摘要：

• 【摘要】目的    探讨替罗非班联合尼可地尔对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）治疗术后血清炎症因子和心功能的影响。方法    选择2016年1月至2018年5月在陕西省延安市人民医院住院行PCI治疗的STEMI患者120例，采用随机数字表法分为对照组和观察组，各60例，对照组介入术中术后给予替罗非班治疗，观察组介入术中术后给予替罗非班联合尼可地尔治疗。比较2组患者PCI前后血清炎症因子高敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）水平，术后不同时点心功能指标左心室舒张末期容积（LVEDV）、左心室射血分数（LVEF）和舒张早期与舒张晚期二尖瓣血流速度比值（E/A）以及术后随访90 d内主要不良心血管事件和治疗期间出血事件发生率。结果    观察组术后24 h血清IL-6水平和术后7 d血清hs-CRP、TNF-α、IL-6水平均低于对照组［(7.6±1.9)ng/L比（8.6±1.8）ng/L、(5.3±0.8)mg/L比（8.6±1.1）mg/L、（159±34）ng/L比(211±43)ng/L、(3.0±1.2)ng/L比（3.7±1.2）ng/L］，差异均有统计学意义（均P＜0.05）。术后90 d，观察组LVEDV显著小于对照组［(85±9)ml比（92±9）ml］，LVEF和E/A高于对照组［(60±5)%比（56±6）%、(1.2±0.3)比（0.9±0.3）］，差异均有统计学意义（均P＜0.05）。与术后24 h比较，2组术后90 d LVEDV均显著增大，LVEF和E/A均明显降低，差异均有统计学意义（均P＜0.05）。2组术后90 d内主要不良心血管事件发生率和治疗期间出血事件发生率比较差异均无统计学意义（P=0.327、1.000）。结论    对于STEMI患者，尼可地尔联合替罗非班较单用替罗非班能有效降低PCI术后急性期内血清炎症因子水平、保护左心室功能。

• 【Abstract】Objective    To investigate the clinical effect of tirofiban combined with nicorandil on acute ST-segment elevation myocardial infarction(STEMI) patients undergoing percutaneous coronary intervention(PCI) and the effect on serum inflammatory factors and cardiac function. Methods    A total of 120 patients with STEMI undergoing PCI in Yan′an People′s Hospital, Shaanxi Province from January 2016 to May 2018 were randomly divided into control group(60 cases) treated with tirofiban and observation group(60 cases) treated with tirofiban plus nicorandil. Serum levels of high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were detected before and after PCI. Left ventricular end-diastolic volume(LVEDV), left ventricular ejection fraction(LVEF) and mitral early diastolic filling velocity(E)/late diastolic filling velocity(A) ratio were monitored at different time points after PCI. Main adverse cardiovascular events(MACE) within 90 days after procedure and bleeding events during treatment were observed. Results    Serum levels of IL-6 at 24 h after PCI, hs-CRP, TNF-α and IL-6 at 7 d after PCI in observation group were significantly lower than those in observation group［(7.6±1.9)ng/L vs （8.6±1.8）ng/L, (5.3±0.8)mg/L vs （8.6±1.1）mg/L, （159±34）ng/L vs (211±43)ng/L, (3.0±1.2)ng/L vs （3.7±1.2）ng/L］（all P＜0.05）. At 90 d after PCI, LVEDV in observation group was significantly lower and LVEF, E/A ratio were higher than those in control group［(85±9)ml vs （92±9）ml, (60±5)% vs （56±6）%, (1.2±0.3) vs （0.9±0.3）］(all P＜0.05). LVEDV increased and LVEF, E/A decreased at 90 d in both groups compared with those at 24 h after PCI（all P＜0.05）. There were no statistical differences in the 90 d MACE and bleeding events between groups(P=0.327, P=1.000). Conclusion    Tirofiban combined with nicorandil treating STEMI patients can significantly reduce inflammation and protect left ventricular function after PCI.