2020 年第 3 期 第 15 卷

促红细胞生成素对ST段抬高型心肌梗死患者介入术后再灌注性心律失常的影响及可能机制

Effect of erythropoietin on reperfusion arrhythmia after coronary intervention in patients with ST-segment elevation myocardial infarction and the relevant mechanism

作者：张玥谭晓

英文作者：

单位：南京医科大学第二附属医院急诊科210000 

英文单位：

关键词：ST段抬高型心肌梗死；再灌注性心律失常；促红细胞生成素

英文关键词：

• 摘要：

• 【摘要】目的    探讨促红细胞生成素（EPO）对ST段抬高型心肌梗死（STEMI）患者介入术后再灌注性心律失常的影响及可能机制。方法    选取2017年1月至2019年1月于南京医科大学第二附属医院行经皮冠状动脉介入(PCI)治疗的STEMI患者96例，按照随机数字表法分为对照组和观察组，各48例。对照组PCI术前静脉滴注0.9%氯化钠注射液；观察组PCI术前给予EPO 100 U/kg静脉滴注。比较2组术后再灌注性心律失常发生情况。比较2组手术前后的二尖瓣血流舒张早期流速（EV）、二尖瓣血流舒张晚期流速（AV）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）及血清胱抑素C、Ⅰ型胶原羧基末端肽（ⅠCTP）、缺血修饰白蛋白（IMA）、C反应蛋白（CRP）、白细胞介素10（IL-10）、巨噬细胞衍生趋化因子（MDC）水平。比较2组术后主要不良心脏事件（MACE）发生情况。结果    观察组术后再灌注性心律失常发生率明显低于对照组［39.6%（19/48）比68.8%（33/48）］（P=0.004）。2组术后7 d EV、AV均明显快于术前，LVEDD、LVESD均明显小于术前，同时观察组术后7 d EV、AV均明显快于对照组，LVEDD、LVESD均明显小于对照组（均P＜0.05）。2组术后7 d血清胱抑素C、IL-10水平均明显高于术前，血清ⅠCTP、IMA、CRP、MDC水平均明显低于术前，同时观察组术后7 d血清胱抑素C、IL-10水平明显高于对照组，血清ICTP、IMA、CRP、MDC水平均明显低于对照组（均P＜0.05）。观察组MACE发生率明显低于对照组［4.2%（2/48）比27.1%（13/48）］（P=0.002）。结论    EPO对STEMI患者介入术后再灌注性心律失常有明显的缓解作用，其作用机制可能与改善心功能、减轻心肌细胞损伤、抑制炎性反应有关。

• 【Abstract】Objective    To explore the mechanism and effect of erythropoietin on reperfusion arrhythmia after percutaneous coronary intervention(PCI) in ST-segment elevation myocardial infarction(STEMI) patients. Methods    From January 2017 to January 2019, 96 patients with STEMI undergoing PCI in the Second Affiliated Hospital of Nanjing Medical University were randomly divided into control group and observation group, with 48 cases in each group. The observation group was treated with erythropoietin 100 U/kg and the control group was treated with 0.9% sodium chloride for intravenous infusion. Incidence of reperfusion arrhythmia was recorded after PCI. Peak early diastolic velocity of mitral valve(EV), peak late diastolic velocity of mitral valve(AV), left ventricular end-diastolic dimension(LVEDD), left ventricular end-systolic dimension(LVESD), serum levels of Cystatin C(CysC), type Ⅰ collagen cross-linked C-terminal peptide(ⅠCTP), ischemia modified albumin(IMA), C-reactive protein(CRP), interleukin-10(IL-10) and macrophage derived chemokine(MDC) were analyzed. Major adverse cardiac events(MACE) were observed.  ResultsIncidence of reperfusion arrhythmia in the observation group was significantly lower than that in the control group［39.6%（19/48） vs 68.8%（33/48）］（P=0.004）. At 7 d after PCI, EV and AV increased, LVEDD and LVESD decreased as compared with before procedure; EV and AV in the observation group were higher but LVEDD and LVESD were lower than those in the control group（all P＜0.05）. Serum levels of CysC and IL-10 increased, ⅠCTP, IMA, CRP and MDC were reduced at 7 d after PCI; CysC and IL-10 in the observation group were higher, ⅠCTP, IMA, CRP and MDC were lower than those in the control group(all P＜0.05). Incidence of MACE in the observation group was significantly lower than that in the control group［4.2%（2/48） vs 27.1%（13/48）］（P=0.002）. Conclusions    Erythropoietin can significantly relieve perfusion arrhythmia after PCI in STEMI patients. The mechanism may be related to the improvement of cardiac function, the reduction of myocardial cell injury and the inhibition of inflammatory response.