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
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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 (c Tn I)、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(χ~2=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。
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( c Tn I),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,c Tn I,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,c Tn I,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.
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( c Tn I),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,c Tn I,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,c Tn I,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.
引文
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[6]孟丹.急性ST段抬高型心肌梗死患者PCI术后并发症的护理[J].航空航天医学杂志,2017,28(9):1127-1129.DOI:10.3969/j.issn.2095-1434.2017.09.052.Meng D.Nursing care of complications after PCI in patients with acute ST-segment elevation myocardial infarction[J].Journal of Aerospace Medicine,2017,28(9):1127-1129.DOI:10.3969/j.issn.2095-1434.2017.09.052.
[7]韩孝宇,安建立,王文广,等.口服尼可地尔对老年STEMI患者急诊PCI围术期心肌保护作用的临床研究[J].实用药物与临床,2018,21(5):520-525.DOI:10.14053/j.cnki.ppcr.201805009.Han XY,An JL,Wang WG,et al.Perioperative myocardial protection of oral administration of nicorandil for senile STEMIpatients undergoing emergency PCI[J].Practical Pharmacy and Clinical Remedies,2018,21(5):520-525.DOI:10.14053/j.cnki.ppcr.201805009.
[8]高翔,王兆翔,纪征,等.替格瑞洛与氯吡格雷对急性冠状动脉综合征介入治疗患者血小板功能影响的比较及临床意义[J].临床内科杂志,2016,33(10):672-674.DOI:10.3969/j.issn.1001-9057.2016.10.007.Gao X,Wang ZX,Ji Z,et al.Comparison of the effects on platelet function of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute coronary syndrome[J].Journal of Clinical Internal Medicine,2016,33(10):672-674.DOI:10.3969/j.issn.1001-9057.2016.10.007.
[9]Krumholz HM,Hennen J,Ridker PM,et al.Use and effectiveness of intravenous heparin therapy for treatment of acute myocardial infarction in the elderly[J].J Am Coll Cardiol,1998,31(5):973-979.
[10]Xu H,Wang B,Meng Q,et al.Effectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure[J].Pak JMed Sci,2017,33(3):540-544.DOI:10.12669/pjms.333.12483.
[11]Miao ZL,Hou AJ,Zang HY,et al.Effects of recombinant human brain natriuretic peptide on the prognosis of patients with acute anterior myocardial infarction undergoing primary percutaneous coronary intervention:a prospective,multi-center,randomized clinical trial[J].J Thorac Dis,2017,9(1):54-63.DOI:10.21037/jtd.2017.01.15.
[12]Bonow RO,Mann DL,Zipes DP,et al.Braunwald's heart disease[M].9th ed.Philadelphia:WB Saunders Co,Elsevier Inc,2012:389-426.
[13]吕静,徐戈,黄琛,等.强化剂量阿托伐他汀对不稳定型心绞痛患者PCI围手术期B7-H3、B7-H4的影响[J].中国动脉硬化杂志,2017,25(6):590-593.DOI:10.3969/j.issn.1007-3949.2017.06.009.Lyu J,Xu G,Huang C,et al.Effect of intensive dose atorvastatin on B7-H3,B7-H4 in patients with unstable angina pectoris undergoing percutaneous coronary intervention[J].Chinese Journal of Arteriosclerosis,2017,25(6):590-593.DOI:10.3969/j.issn.1007-3949.2017.06.009.
[14]姜荣泸,李正义.急性冠状动脉综合征患者PCI术后长期应用替格瑞洛抗血小板治疗的疗效及安全性观察[J].解放军医药杂志,2017,29(12):36-38,45.DOI:10.3969/j.issn.2095-140X.2017.12.010.Jiang RL,Li ZY.Efficacy and safety of tegrelol long-term antiplatelet therapy in treatment of patients with acute coronary syndrome after percataneous coronary artery interventional therapy[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2017,29(12):36-38,45.DOI:10.3969/j.issn.2095-140X.2017.12.010.
[15]李凡,马燚,王建辉,等.高血压对急性ST段抬高型心肌梗死经皮冠状动脉介入近期预后的影响[J].解放军医药杂志,2017,29(11):47-49.DOI:10.3969/j.issn.2095-140X.2017.11.012.Li F,Ma Y,Wang JH,et al.Effect of hypertension on short-term prognosis of patients with ST-elevation myocardial infarction by percutaneous coronary artery intervention[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2017,29(11):47-49.DOI:10.3969/j.issn.2095-140X.2017.11.012.
[2]China PEACE研究协作组.2001~2011年东部农村地区医院急性心肌梗死心肌标志物检测的变化趋势---China PEACE回顾性急性心肌梗死研究结果[J].中国循环杂志,2017,32(6):547-551.DOI:10.3969/j.issn.1000-3614.2017.06.005.China PEACE Research Collaboration Group.The changing trends of cardiac biomarker test in acute myocardial infarction patients during 2001-2011 in eastern rural hospitals of China-China PEACE retrospective study in acute myocardial infarction[J].Chinese Circulation Journal,2017,32(6):547-551.DOI:10.3969/j.issn.1000-3614.2017.06.005.
[3]温继梨,崔晓迎.血必净对行急诊PCI治疗的AMI患者凝血功能的影响[J].实用药物与临床,2015,18(12):1446-1448.DOI:10.14053/j.cnki.ppcr.201512012.Wen JL,Cui XY.Effects of xuebijing injection on coagulation function of AMI patients with emergency PCI treatment[J].Practical Pharmacy and Clinical Remedies,2015,18(12):1446-1448.DOI:10.14053/j.cnki.ppcr.201512012.
[4]杨丽.急性心肌梗死患者PCI术后并发急性脑梗死的发生率及危险因素分析[J].中国实用神经疾病杂志,2017,20(3):99-101.DOI:10.3969/j.issn.1673-5110.2017.03.043.Yang L.Incidence and risk factors of acute cerebral infarction after PCI in patients with acute myocardial infarction[J].Chinese Journal of Practical Nervous Diseases,2017,20(3):99-101.DOI:10.3969/j.issn.1673-5110.2017.03.043.
[5]高云,李志忠,林运.经皮冠状动脉介入术后心脏运动康复治疗研究进展[J].中国医药,2018,13(10):1579-1581.DOI:10.3760/j.issn.1673-4777.2018.10.035.Gao Y,Li ZZ,Lin Y.Research progress in cardiac exercise rehabilitation after percutaneous coronary intervention[J].China Medicine,2018,13(10):1579-1581.DOI:10.3760/j.issn.1673-4777.2018.10.035.
[6]孟丹.急性ST段抬高型心肌梗死患者PCI术后并发症的护理[J].航空航天医学杂志,2017,28(9):1127-1129.DOI:10.3969/j.issn.2095-1434.2017.09.052.Meng D.Nursing care of complications after PCI in patients with acute ST-segment elevation myocardial infarction[J].Journal of Aerospace Medicine,2017,28(9):1127-1129.DOI:10.3969/j.issn.2095-1434.2017.09.052.
[7]韩孝宇,安建立,王文广,等.口服尼可地尔对老年STEMI患者急诊PCI围术期心肌保护作用的临床研究[J].实用药物与临床,2018,21(5):520-525.DOI:10.14053/j.cnki.ppcr.201805009.Han XY,An JL,Wang WG,et al.Perioperative myocardial protection of oral administration of nicorandil for senile STEMIpatients undergoing emergency PCI[J].Practical Pharmacy and Clinical Remedies,2018,21(5):520-525.DOI:10.14053/j.cnki.ppcr.201805009.
[8]高翔,王兆翔,纪征,等.替格瑞洛与氯吡格雷对急性冠状动脉综合征介入治疗患者血小板功能影响的比较及临床意义[J].临床内科杂志,2016,33(10):672-674.DOI:10.3969/j.issn.1001-9057.2016.10.007.Gao X,Wang ZX,Ji Z,et al.Comparison of the effects on platelet function of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute coronary syndrome[J].Journal of Clinical Internal Medicine,2016,33(10):672-674.DOI:10.3969/j.issn.1001-9057.2016.10.007.
[9]Krumholz HM,Hennen J,Ridker PM,et al.Use and effectiveness of intravenous heparin therapy for treatment of acute myocardial infarction in the elderly[J].J Am Coll Cardiol,1998,31(5):973-979.
[10]Xu H,Wang B,Meng Q,et al.Effectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure[J].Pak JMed Sci,2017,33(3):540-544.DOI:10.12669/pjms.333.12483.
[11]Miao ZL,Hou AJ,Zang HY,et al.Effects of recombinant human brain natriuretic peptide on the prognosis of patients with acute anterior myocardial infarction undergoing primary percutaneous coronary intervention:a prospective,multi-center,randomized clinical trial[J].J Thorac Dis,2017,9(1):54-63.DOI:10.21037/jtd.2017.01.15.
[12]Bonow RO,Mann DL,Zipes DP,et al.Braunwald's heart disease[M].9th ed.Philadelphia:WB Saunders Co,Elsevier Inc,2012:389-426.
[13]吕静,徐戈,黄琛,等.强化剂量阿托伐他汀对不稳定型心绞痛患者PCI围手术期B7-H3、B7-H4的影响[J].中国动脉硬化杂志,2017,25(6):590-593.DOI:10.3969/j.issn.1007-3949.2017.06.009.Lyu J,Xu G,Huang C,et al.Effect of intensive dose atorvastatin on B7-H3,B7-H4 in patients with unstable angina pectoris undergoing percutaneous coronary intervention[J].Chinese Journal of Arteriosclerosis,2017,25(6):590-593.DOI:10.3969/j.issn.1007-3949.2017.06.009.
[14]姜荣泸,李正义.急性冠状动脉综合征患者PCI术后长期应用替格瑞洛抗血小板治疗的疗效及安全性观察[J].解放军医药杂志,2017,29(12):36-38,45.DOI:10.3969/j.issn.2095-140X.2017.12.010.Jiang RL,Li ZY.Efficacy and safety of tegrelol long-term antiplatelet therapy in treatment of patients with acute coronary syndrome after percataneous coronary artery interventional therapy[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2017,29(12):36-38,45.DOI:10.3969/j.issn.2095-140X.2017.12.010.
[15]李凡,马燚,王建辉,等.高血压对急性ST段抬高型心肌梗死经皮冠状动脉介入近期预后的影响[J].解放军医药杂志,2017,29(11):47-49.DOI:10.3969/j.issn.2095-140X.2017.11.012.Li F,Ma Y,Wang JH,et al.Effect of hypertension on short-term prognosis of patients with ST-elevation myocardial infarction by percutaneous coronary artery intervention[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2017,29(11):47-49.DOI:10.3969/j.issn.2095-140X.2017.11.012.