利拉鲁肽对急性心肌梗死PCI术后心肌的保护作用
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摘要
目的:探讨利拉鲁肽对急性心肌梗死(AMI)经皮冠状动脉介入术(PCI)术后心肌的保护作用。方法:将110例于我院就诊的初发AMI并发应激性高血糖的患者分为两组,各55例;在常规标准治疗的基础上,观察组患者给予利拉鲁肽治疗,对照组患者采用胰岛素治疗;分别于PCI术前以及术后测定血液肌酸磷酸激酶(CK)、血肌酸激酶同工酶(CKMB)、肌钙蛋白T(cTnT)、B型利钠肽前体(NT-pro-BNP)及超敏C反应蛋白(hs-CRP)比较心肌损伤情况;测定术后7 d及30d的心肌灌注缺损积分、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)比较心功能恢复情况。结果:两组患者术后CK、CKMB、cTnT、hs-CRP均明显升高(P<0.05),NT-proBNP明显降低(P<0.05),观察组48 h峰值明显低于对照组(t=5.188、7.081、2.180、5.091、4.748,P<0.05);心肌灌注缺损积分两组术后30 d指标较7 d时降低,对照组下降明显(t=7.963,P<0.05),术后7 d观察组明显低于对照组(t=6.235,P<0.05)。LVEF、LVEDD术后30d指标较7 d时升高,观察组LVEF差异显著(t=2.016,P<0.05);同期组间比较,术后30 d LVEF差异显著(t=2.032,P<0.05),其余差异不明显(P>0.05)。结论:利拉鲁肽可在AMI患者PCI术后对心肌发挥一定的保护作用。
AIM: To investigate the protective effects of liraglutide on myocardium in acute myocardial infarction( AMI) patients treated with percutaneous coronary intervention( PCI). METHODS:One hundred and ten cases of patients diagnosed as AMI, complicated with stress hyperglycemia and treated with PCI were divided into two groups,55 cases each. Besides standard treatments,observation group was treated with liraglutide while control group was treated with insulin. Factors including creatine phosphokinase( CK), creatine kinase isoenzymes( CKMB), serum cardiac troponin T( cTnT),high-sensitivity C-reactive protein( hsCRP),nitrogen terminal pro-brain natriuretic peptide( NT-pro-BNP),left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVEDD) and myocardium perfusion defect score were tested before and after treatment between the two groups to compare the efficacy of the two therapeutics. RESULTS: After the surgery,CK,CKMB,cTnT and hs-CRP significantly increased( P <0. 05) while NT-pro-BNP decreased significantly( P< 0. 05) in both groups,and the 48 h peak values of these factors in observation group were significantly lower than those in the control group( t = 5. 188,7. 081,2. 180,5. 091,4. 748,P < 0. 05). Compared within groups,the myocardial perfusion defect score at day 30 decreased as compared with day 7 both in the control group( significantly,t = 7. 963,P < 0. 05) and in the observation group( not obviously,P > 0. 05). Compared between the groups,the index in the observation group were lower than that in the control group both at day 7( significantly,t = 6. 235,P < 0. 05) and day 30( not obviously,P > 0. 05). LVEF,LVEDD at day 30 increased compared with the indexes at day 7 in both groups,and the differences in the control group were significant( t = 6. 235,P < 0. 05). Comparison within the groups showed significant difference between the 30 d LVEF( t = 2. 032,P < 0. 05),while other differences were not significant( P > 0. 05). CONCLUSION: Liraglutide exhibits protective effects on myocardium of AMI patients treated with PCI.
AIM: To investigate the protective effects of liraglutide on myocardium in acute myocardial infarction( AMI) patients treated with percutaneous coronary intervention( PCI). METHODS:One hundred and ten cases of patients diagnosed as AMI, complicated with stress hyperglycemia and treated with PCI were divided into two groups,55 cases each. Besides standard treatments,observation group was treated with liraglutide while control group was treated with insulin. Factors including creatine phosphokinase( CK), creatine kinase isoenzymes( CKMB), serum cardiac troponin T( cTnT),high-sensitivity C-reactive protein( hsCRP),nitrogen terminal pro-brain natriuretic peptide( NT-pro-BNP),left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVEDD) and myocardium perfusion defect score were tested before and after treatment between the two groups to compare the efficacy of the two therapeutics. RESULTS: After the surgery,CK,CKMB,cTnT and hs-CRP significantly increased( P <0. 05) while NT-pro-BNP decreased significantly( P< 0. 05) in both groups,and the 48 h peak values of these factors in observation group were significantly lower than those in the control group( t = 5. 188,7. 081,2. 180,5. 091,4. 748,P < 0. 05). Compared within groups,the myocardial perfusion defect score at day 30 decreased as compared with day 7 both in the control group( significantly,t = 7. 963,P < 0. 05) and in the observation group( not obviously,P > 0. 05). Compared between the groups,the index in the observation group were lower than that in the control group both at day 7( significantly,t = 6. 235,P < 0. 05) and day 30( not obviously,P > 0. 05). LVEF,LVEDD at day 30 increased compared with the indexes at day 7 in both groups,and the differences in the control group were significant( t = 6. 235,P < 0. 05). Comparison within the groups showed significant difference between the 30 d LVEF( t = 2. 032,P < 0. 05),while other differences were not significant( P > 0. 05). CONCLUSION: Liraglutide exhibits protective effects on myocardium of AMI patients treated with PCI.
引文
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[7]夏梅华,鲍希静,李萍,等.通心络胶囊联合替罗非班对急性心肌梗死PCI术后患者血栓再形成和炎症因子影响的研究[J].中医药导报,2016,13(5):92-94.
[8]樊宗成.急性心肌梗死伴随应激性高血糖患者冠状动脉造影及临床分析[J].中国动脉硬化杂志,2014,22(4):404-406.
[9]高淑娟,王艾英,张一兵.应激性高血糖对非糖尿病急性心肌梗死预后的影响[J].中国煤炭工业医学杂志,2016,19(11):1541-1544.
[10]陈敏,吕莉,孙晓兰,等.心肌酶和红细胞形态学参数与心肌梗死的相关性研究[J].现代生物医学进展,2016,16(12):2339-2341.
[11]马宏,王利青,尤兆雄.NT-proBNP下降率与急性心肌梗死患者预后的研究[J].中国循证心血管医学杂志,2015,12(1):47-48.
[12]陈韦任,陈韵岱.利拉鲁肽对急诊行经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者心功能的影响[J].中华内科杂志,2016,55(4):327.
[13]朱恩波,赵光贤,成宪武.PCI术前后GLP-1受体激动剂治疗对ST段抬高心肌梗死心肌保护作用[J].中国心血管病研究,2014,12(12):1133-1135.
[2]Mapanga RF,Essop MF.The damaging effects of hyperglycemia on cardiovascular function:spotlight on glucose metabolic pathways[J].Am J Physiol Heart Circul Physiol,2016,310(2):H153-173.
[3]Seufert J,Gallwitz B.The extra-pancreatic effects of GLP-1 receptor agonists:a focus on the cardiovascular,gastrointestinal and central nervous systems[J].Diabetes Obes Metab,2014,16(8):673-688.
[4]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[5]买泓,宁靓,赵刚.静脉溶栓与PCI对急性心肌梗死的疗效对比[J].重庆医学,2014,8(9):1133-1135.
[6]史云桃,蒋廷波.急性ST段抬高心肌梗死患者合并心力衰竭的危险因素分析[J].中华老年心脑血管病杂志,2014,16(2):151-154.
[7]夏梅华,鲍希静,李萍,等.通心络胶囊联合替罗非班对急性心肌梗死PCI术后患者血栓再形成和炎症因子影响的研究[J].中医药导报,2016,13(5):92-94.
[8]樊宗成.急性心肌梗死伴随应激性高血糖患者冠状动脉造影及临床分析[J].中国动脉硬化杂志,2014,22(4):404-406.
[9]高淑娟,王艾英,张一兵.应激性高血糖对非糖尿病急性心肌梗死预后的影响[J].中国煤炭工业医学杂志,2016,19(11):1541-1544.
[10]陈敏,吕莉,孙晓兰,等.心肌酶和红细胞形态学参数与心肌梗死的相关性研究[J].现代生物医学进展,2016,16(12):2339-2341.
[11]马宏,王利青,尤兆雄.NT-proBNP下降率与急性心肌梗死患者预后的研究[J].中国循证心血管医学杂志,2015,12(1):47-48.
[12]陈韦任,陈韵岱.利拉鲁肽对急诊行经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者心功能的影响[J].中华内科杂志,2016,55(4):327.
[13]朱恩波,赵光贤,成宪武.PCI术前后GLP-1受体激动剂治疗对ST段抬高心肌梗死心肌保护作用[J].中国心血管病研究,2014,12(12):1133-1135.