经皮桡动脉穿刺介入术联合美托洛尔对冠心病并心力衰竭患者心功能、颈动脉内膜中层厚度及血清脂联素、同型半胱氨酸水平的影响
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摘要
目的探讨经皮桡动脉穿刺介入术联合美托洛尔对冠心病并心力衰竭患者心功能、颈动脉内膜中层厚度及血清脂联素(APN)、同型半胱氨酸(Hcy)水平的影响。方法选取2015年2月—2017年6月四川绵阳四0四医院心内科收治的冠心病并心力衰竭患者120例,采用随机数字表法分为美托洛尔组(n=40)、介入组(n=40)、联合组(n=40)。在常规药物治疗基础上,美托洛尔组患者给予美托洛尔治疗;介入组患者给予经皮桡动脉穿刺介入术治疗;联合组患者给予经皮桡动脉穿刺介入术联合美托洛尔治疗。比较3组患者治疗前7 d及治疗后1个月心功能指标〔包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕、颈动脉内膜中层厚度(CIMT)及血清APN、Hcy水平,并观察3组患者随访1年不良心血管事件发生情况。结果 (1)3组患者治疗前7 d LVEF、LVEDD、LVESD比较,差异无统计学意义(P>0.05)。治疗后1个月联合组患者LVEF高于美托洛尔组和介入组,LVEDD、LVESD短于美托洛尔组和介入组(P<0.05);介入组患者LVEF高于美托洛尔组,LVEDD、LVESD短于美托洛尔组(P<0.05)。(2)3组患者治疗前7 d CIMT及血清APN、Hcy水平比较,差异无统计学意义(P>0.05)。治疗后1个月联合组患者CIMT小于美托洛尔组和介入组,血清APN水平高于美托洛尔组和介入组,血清Hcy水平低于美托洛尔组和介入组(P>0.05);介入组患者CIMT小于美托洛尔组,血清APN水平高于美托洛尔组(P<0.05)。(3)随访1年3组患者不良心血管事件发生率比较,差异无统计学意义(P>0.05)。结论经皮桡动脉穿刺介入术联合美托洛尔可有效改善冠心病并心力衰竭患者心功能,降低患者CIMT及血清Hcy水平,提高患者血清APN水平,有利于降低动脉粥样硬化发生风险及冠状动脉粥样硬化斑块负荷。
Objective To investigate the impact of percutaneous radial artery puncture intervention combined with metoprolol on cardiac function,carotid intima media thickness(CIMT),serum levels of adiponectin and homocysteine in coronary heart disease patients complicated with heart failure. Methods From February 2015 to June 2017,a total of 120 coronary heart disease patients complicated with heart failure were selected in the Department of Cardiovascular Medicine,Sichuan Mianyang 404 Hospital,and they were divided into metoprolol group,intervention group and union group,with 40 cases in each group. Based on conventional medical treatment,patients in metoprolol group received metoprolol only,patients in intervention group received percutaneous radial artery puncture intervention only,while patients in union group received metoprolol combined with percutaneous radial artery puncture intervention. Index of cardiac function(including LVEF,LVEDD and LVESD),CIMT,serum levels of adiponectin and homocysteine were compared between the two groups 7 days before treatment and 1 month after treatment,and incidence of adverse cardiac events was observed during 1-year follow-up. Results(1)No statistically significant difference of LVEF,LVEDD or LVESD was found in the three groups 7 days before treatment(P>0.05).After 1 month of treatment,LVEF in union group was statistically significantly higher than that in metoprolol group and intervention group,respectively,while LVEDD and LVESD in union group were statistically significantly shorter than those in metoprolol group and intervention group(P<0.05);LVEF in intervention group was statistically significantly higher than that in metoprolol group,while LVEDD and LVESD in intervention group were statistically significantly shorter than those in metoprolol group(P<0.05).(2)No statistically significant difference of CIMT,serum level of APN or Hcy was found in the three groups before treatment(P>0.05). After 1 month of treatment,CIMT in union group was statistically significantly more thin than that in metoprolol group and intervention group,respectively,serum adiponectin level in union group was statistically significantly higher than that in metoprolol group and intervention group,respectively,while serum homocysteine level in union group was statistically significantly lower than that in metoprolol group and intervention group,respectively(P<0.05);CIMT in intervention group was statistically significantly more thin than that in metoprolol group,serum adiponectin level in intervention group was statistically significantly higher than that in metoprolol group(P<0.05).(3)No statistically significant difference of incidence of adverse cardiac events was found in the three groups during 1-year follow-up(P>0.05).Conclusion In coronary heart disease patients complicated with heart failure,percutaneous radial artery puncture intervention combined with metoprolol can effectively improve the cardiac function and serum adiponectin level,reduce the CIMT and serum homocysteine level,which is helpful to reduce the risk of atherosclerosis and coronary atherosclerotic plaque load.
Objective To investigate the impact of percutaneous radial artery puncture intervention combined with metoprolol on cardiac function,carotid intima media thickness(CIMT),serum levels of adiponectin and homocysteine in coronary heart disease patients complicated with heart failure. Methods From February 2015 to June 2017,a total of 120 coronary heart disease patients complicated with heart failure were selected in the Department of Cardiovascular Medicine,Sichuan Mianyang 404 Hospital,and they were divided into metoprolol group,intervention group and union group,with 40 cases in each group. Based on conventional medical treatment,patients in metoprolol group received metoprolol only,patients in intervention group received percutaneous radial artery puncture intervention only,while patients in union group received metoprolol combined with percutaneous radial artery puncture intervention. Index of cardiac function(including LVEF,LVEDD and LVESD),CIMT,serum levels of adiponectin and homocysteine were compared between the two groups 7 days before treatment and 1 month after treatment,and incidence of adverse cardiac events was observed during 1-year follow-up. Results(1)No statistically significant difference of LVEF,LVEDD or LVESD was found in the three groups 7 days before treatment(P>0.05).After 1 month of treatment,LVEF in union group was statistically significantly higher than that in metoprolol group and intervention group,respectively,while LVEDD and LVESD in union group were statistically significantly shorter than those in metoprolol group and intervention group(P<0.05);LVEF in intervention group was statistically significantly higher than that in metoprolol group,while LVEDD and LVESD in intervention group were statistically significantly shorter than those in metoprolol group(P<0.05).(2)No statistically significant difference of CIMT,serum level of APN or Hcy was found in the three groups before treatment(P>0.05). After 1 month of treatment,CIMT in union group was statistically significantly more thin than that in metoprolol group and intervention group,respectively,serum adiponectin level in union group was statistically significantly higher than that in metoprolol group and intervention group,respectively,while serum homocysteine level in union group was statistically significantly lower than that in metoprolol group and intervention group,respectively(P<0.05);CIMT in intervention group was statistically significantly more thin than that in metoprolol group,serum adiponectin level in intervention group was statistically significantly higher than that in metoprolol group(P<0.05).(3)No statistically significant difference of incidence of adverse cardiac events was found in the three groups during 1-year follow-up(P>0.05).Conclusion In coronary heart disease patients complicated with heart failure,percutaneous radial artery puncture intervention combined with metoprolol can effectively improve the cardiac function and serum adiponectin level,reduce the CIMT and serum homocysteine level,which is helpful to reduce the risk of atherosclerosis and coronary atherosclerotic plaque load.
引文
[1]彭庆.使用美托洛尔和曲美他嗪对并发心力衰竭的冠心病患者进行治疗的效果观察[J].当代医药论丛,2016,15(15):102-103.
[2]袁毅,刘军翔.尼可地尔对PCI术后心绞痛患者疗效及丙二醛与脂联素水平的影响[J].武警后勤学院学报(医学版),2017,26(9):762-765.DOI:10.16548/j.2095-3720.2017.09.008.
[3]王启东,赖木乔.美托洛尔联合芪参益气滴丸治疗冠心病并发心力衰竭患者的疗效观察[J].临床合理用药杂志,2018,11(11):26-27.DOI:10.15887/j.cnki.13-1389/r.2018.11.013.
[4]秦立,赵莹,张斌.丹红注射液联合瑞舒伐他汀对急性心肌梗死PCI术后心肌无复流及IL-6、Cys-C、Hcy的影响[J].中西医结合心脑血管病杂志,2018,16(17):2453-2456.DOI:10.12102/j.issn.1672-1349.2018.17.004
[5]杨波,邓云超,谭利国,等.经皮冠状动脉介入再通对冠状动脉慢性完全闭塞性病变患者左室心肌重塑的影响[J].中国循证心血管医学杂志,2018,10(4):410-413,417.DOI:10.3969/j.issn.1674-4055.2018.04.06.
[6]兰振和,王岩,胡志鹏,等.经皮桡动脉穿刺介入术配合美托洛尔治疗冠心病并发心力衰竭疗效及对患者心功能的影响研究[J].陕西医学杂志,2018,47(5):593-596.
[7]张媛.美托洛尔与曲美他嗪治疗老年冠心病心力衰竭的疗效及对患者心功能、心肌重塑和炎症因子的影响[J].中外医疗,2017,36(29):129-131.DOI:10.16662/j.cnki.1674-0742.2017.29.129.
[8]回振宇.经皮桡动脉穿刺介入治疗冠心病的临床效果评价[J].中国医药指南,2017,15(1):54-55.DOI:10.15912/j.cnki gocm.2017.01.042.
[9]邓婷婷,华永平,席罡,等.HbA1c与冠心病患者经皮桡动脉穿刺介入治疗预后的相关性研究[J].中国现代医生,2017,55(10):16-18.
[10]顾丽萍,胡菁,严蜀华.美托洛尔与曲美他嗪治疗老年冠心病心力衰竭的疗效及对患者心功能、心肌重塑和炎症因子的影响[J].中国老年学杂志,2017,37(1):89-91.DOI:10.3969/j.issn.1005-9202.2017.01.038.
[11]谭艳武.冠脉介入治疗冠心病急性心肌梗死的临床疗效及对心室重塑影响[J].当代医学,2018,24(22):76-78.
[12]张丽枫,高维.美托洛尔对心力衰竭患者APN和TNF-α水平的影响[J].中外医疗,2017,36(35):143-145.DOI:10.16662/j.cnki.1674-0742.2017.35.143.
[13]甄莉景,刘士霞,陈宝虎.维格列汀联合美托洛尔对2型糖尿病合并冠心病患者血清APN、Hcy及IMT水平的影响[J]临床合理用药杂志,2016,9(8):26-27.DOI:10.15887/j.cnki.13-1389/r.2016.08.014.
[14]孙淑艳,裴汉军,郑玉云.阿托伐他汀对ACS病人PCI术后血清脂联素、瘦素、抵抗素的影响[J].中西医结合心脑血管病杂志,2018,16(1):80-82.DOI:10.3969/j.issn.1672-1349.2018.01.021.
[15]李娜.不同剂量阿托伐他汀对PCI患者脂联素、网膜素-1水平及MACE事件的影响[D].石家庄:河北医科大学,2017.
[16]刘宇.冠脉介入对冠心病急性心肌梗死患者血浆B型钠利尿肽水平及对心室重塑的影响[J].临床和实验医学杂志,2016,15(1):34-36.DOI:10.3969/j.issn.1671-4695.2016.01.012.
[17]孟锐,李新建,何水波,等.PCI术后冠心病患者血清同型半胱氨酸水平与病情预后的相关性分析[J].临床和实验医学杂志,2017,16(10):1039-1040,后插1.DOI:10.3969/j.issn.1671-4695.2017.10.034.
[18]艾民,颜昌福,夏福纯,等.冠心病患者PCI术前血清同型半胱氨酸水平与术后对比剂肾病的相关性分析[J].江苏医药,2018,44(4):426-428,431.DOI:10.19460/j.cnki.0253-3685.2018.04.022.
[2]袁毅,刘军翔.尼可地尔对PCI术后心绞痛患者疗效及丙二醛与脂联素水平的影响[J].武警后勤学院学报(医学版),2017,26(9):762-765.DOI:10.16548/j.2095-3720.2017.09.008.
[3]王启东,赖木乔.美托洛尔联合芪参益气滴丸治疗冠心病并发心力衰竭患者的疗效观察[J].临床合理用药杂志,2018,11(11):26-27.DOI:10.15887/j.cnki.13-1389/r.2018.11.013.
[4]秦立,赵莹,张斌.丹红注射液联合瑞舒伐他汀对急性心肌梗死PCI术后心肌无复流及IL-6、Cys-C、Hcy的影响[J].中西医结合心脑血管病杂志,2018,16(17):2453-2456.DOI:10.12102/j.issn.1672-1349.2018.17.004
[5]杨波,邓云超,谭利国,等.经皮冠状动脉介入再通对冠状动脉慢性完全闭塞性病变患者左室心肌重塑的影响[J].中国循证心血管医学杂志,2018,10(4):410-413,417.DOI:10.3969/j.issn.1674-4055.2018.04.06.
[6]兰振和,王岩,胡志鹏,等.经皮桡动脉穿刺介入术配合美托洛尔治疗冠心病并发心力衰竭疗效及对患者心功能的影响研究[J].陕西医学杂志,2018,47(5):593-596.
[7]张媛.美托洛尔与曲美他嗪治疗老年冠心病心力衰竭的疗效及对患者心功能、心肌重塑和炎症因子的影响[J].中外医疗,2017,36(29):129-131.DOI:10.16662/j.cnki.1674-0742.2017.29.129.
[8]回振宇.经皮桡动脉穿刺介入治疗冠心病的临床效果评价[J].中国医药指南,2017,15(1):54-55.DOI:10.15912/j.cnki gocm.2017.01.042.
[9]邓婷婷,华永平,席罡,等.HbA1c与冠心病患者经皮桡动脉穿刺介入治疗预后的相关性研究[J].中国现代医生,2017,55(10):16-18.
[10]顾丽萍,胡菁,严蜀华.美托洛尔与曲美他嗪治疗老年冠心病心力衰竭的疗效及对患者心功能、心肌重塑和炎症因子的影响[J].中国老年学杂志,2017,37(1):89-91.DOI:10.3969/j.issn.1005-9202.2017.01.038.
[11]谭艳武.冠脉介入治疗冠心病急性心肌梗死的临床疗效及对心室重塑影响[J].当代医学,2018,24(22):76-78.
[12]张丽枫,高维.美托洛尔对心力衰竭患者APN和TNF-α水平的影响[J].中外医疗,2017,36(35):143-145.DOI:10.16662/j.cnki.1674-0742.2017.35.143.
[13]甄莉景,刘士霞,陈宝虎.维格列汀联合美托洛尔对2型糖尿病合并冠心病患者血清APN、Hcy及IMT水平的影响[J]临床合理用药杂志,2016,9(8):26-27.DOI:10.15887/j.cnki.13-1389/r.2016.08.014.
[14]孙淑艳,裴汉军,郑玉云.阿托伐他汀对ACS病人PCI术后血清脂联素、瘦素、抵抗素的影响[J].中西医结合心脑血管病杂志,2018,16(1):80-82.DOI:10.3969/j.issn.1672-1349.2018.01.021.
[15]李娜.不同剂量阿托伐他汀对PCI患者脂联素、网膜素-1水平及MACE事件的影响[D].石家庄:河北医科大学,2017.
[16]刘宇.冠脉介入对冠心病急性心肌梗死患者血浆B型钠利尿肽水平及对心室重塑的影响[J].临床和实验医学杂志,2016,15(1):34-36.DOI:10.3969/j.issn.1671-4695.2016.01.012.
[17]孟锐,李新建,何水波,等.PCI术后冠心病患者血清同型半胱氨酸水平与病情预后的相关性分析[J].临床和实验医学杂志,2017,16(10):1039-1040,后插1.DOI:10.3969/j.issn.1671-4695.2017.10.034.
[18]艾民,颜昌福,夏福纯,等.冠心病患者PCI术前血清同型半胱氨酸水平与术后对比剂肾病的相关性分析[J].江苏医药,2018,44(4):426-428,431.DOI:10.19460/j.cnki.0253-3685.2018.04.022.