阿替普酶溶栓联合阿司匹林、氯吡格雷、依诺肝素治疗STEMI的疗效及其对患者血清NT-proBNP、Lp(a)、β_2M水平的影响
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摘要
目的探讨阿替普酶溶栓联合阿司匹林、氯吡格雷、依诺肝素治疗急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)的疗效及其对患者血浆N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NTproBNP)、脂蛋白(a)[lipoproteina,Lp(a)]、β_2微球蛋白(β_2-microglobulin,β_2M)水平的影响。方法选取本院2016年3月至2017年12月收治的STEMI患者130例为研究对象,均采用阿替普酶溶栓治疗,阿司匹林和氯吡格雷抗血小板治疗,依诺肝素抗凝治疗。治疗前、治疗1周、治疗3个月,分别检测患者NT-proBNP、肌酸激酶同工酶(creatine kinase isozyme-MB,CKMB)、Lp(a)、β_2M水平及左室射血分数(left ventricular ejection fraction,LVEF)。随访6个月和1年,分别记录患者心血管不良事件及治疗期间不良反应发生情况。结果治疗1周和治疗3个月,患者NT-proBNP和CK-MB水平均显著低于治疗前(均P <0.05),且患者治疗3个月的NT-proBNP水平显著低于治疗1周的水平(P <0.05)。治疗3个月,患者LVEF均显著大于治疗前和治疗1周(均P <0.05),Lp(a)、β_2M水平均显著低于治疗前和治疗1周(均P <0.05)。治疗6个月和1年,患者再梗死率分别为3.85%和6.92%,冠状动脉内血栓发生率分别为4.62%和10.77%,心源性猝死率分别为0.77%和3.85%,药物不良反应发生率低。结论阿替普酶溶栓联合阿司匹林、氯吡格雷及依诺肝素治疗可以明显改善STEMI患者心功能,有效预防心血管不良事件发生,对患者血清NT-pro BNP、Lp(a)、β_2M也具有良好的调节作用。
Objective To explore the efficacy of Alteplase thrombolysis combined with Aspirin, Clopidogrel and Enoxaparin in the treatment of acute ST-segment elevation myocardial infarction(STEMI) and its effects on levels of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP), lipoprotein(a) [Lp(a)] and β_2-microglobulin(β_2 M). Method A total of 130 patients with STEMI treated in our hospital from March 2016 to December 2017 were treated with Atripase, Aspirin and Clopidogrel antiplatelet therapy and Enoxaparin anticoagulation therapy. The levels of NT-proBNP, creatine kinase isozyme-MB(CK-MB), Lp(a), β_2 M and left ventricular ejection fraction(LVEF) were measured before treatment, 1 week and 3 months after treatment. All patients were followed up for 6 months and 1 year, and the incidence of cardiovascular adverse events and adverse reactions during treatment were recorded. Result The levels of NT-proBNP and CK-MB in patients after 1 week and 3 months of treatment were significantly lower than those before treatment(all P < 0.05), and the level of NT-proBNP in patients after 3 months of treatment was significantly lower than that of 1 week(P < 0.05). After 3 months of treatment, the levels of LVEF in patients were significantly higher than those before treatment and 1 week after treatment(all P < 0.05),while the levels of Lp(a) and β_2 M in patients were significantly lower than those before treatment and 1 week after treatment(all P < 0.05).After 6 months and 1 year of treatment, the reinfarction rate was 3.85% and 6.92%, the incidence of intracoronary thrombosis was 4.62%and 10.77%, and the sudden cardiac death rate was 0.77% and 3.85%, respectively. The incidence of adverse drug reactions was low.Conclusion Alteplase thrombolysis combined with Aspirin, Clopidogrel and Enoxaparin can significantly improve cardiac function,effectively prevent cardiovascular adverse events, and regulate serum NT-proBNP, Lp(a) and β_2 M in patients with STEMI.
Objective To explore the efficacy of Alteplase thrombolysis combined with Aspirin, Clopidogrel and Enoxaparin in the treatment of acute ST-segment elevation myocardial infarction(STEMI) and its effects on levels of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP), lipoprotein(a) [Lp(a)] and β_2-microglobulin(β_2 M). Method A total of 130 patients with STEMI treated in our hospital from March 2016 to December 2017 were treated with Atripase, Aspirin and Clopidogrel antiplatelet therapy and Enoxaparin anticoagulation therapy. The levels of NT-proBNP, creatine kinase isozyme-MB(CK-MB), Lp(a), β_2 M and left ventricular ejection fraction(LVEF) were measured before treatment, 1 week and 3 months after treatment. All patients were followed up for 6 months and 1 year, and the incidence of cardiovascular adverse events and adverse reactions during treatment were recorded. Result The levels of NT-proBNP and CK-MB in patients after 1 week and 3 months of treatment were significantly lower than those before treatment(all P < 0.05), and the level of NT-proBNP in patients after 3 months of treatment was significantly lower than that of 1 week(P < 0.05). After 3 months of treatment, the levels of LVEF in patients were significantly higher than those before treatment and 1 week after treatment(all P < 0.05),while the levels of Lp(a) and β_2 M in patients were significantly lower than those before treatment and 1 week after treatment(all P < 0.05).After 6 months and 1 year of treatment, the reinfarction rate was 3.85% and 6.92%, the incidence of intracoronary thrombosis was 4.62%and 10.77%, and the sudden cardiac death rate was 0.77% and 3.85%, respectively. The incidence of adverse drug reactions was low.Conclusion Alteplase thrombolysis combined with Aspirin, Clopidogrel and Enoxaparin can significantly improve cardiac function,effectively prevent cardiovascular adverse events, and regulate serum NT-proBNP, Lp(a) and β_2 M in patients with STEMI.
引文
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[13]刘浙波,夏豪,童随阳,等.阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死疗效与安全性的Meta分析[J].疑难病杂志,2015,14(2):191-195.
[14]Lanas A,Gargallo CJ.Management of low-dose aspirin and clopidogrel in clinical practice:a gastrointestinal perspective[J].J Gastroenterol,2015,50(6):626-637.
[15]刘华,关韶峰,倪幼方.依诺肝素和普通肝素对不稳定心绞痛及非ST段抬高心肌梗死患者外源性凝血系统和血小板活性的影响[J].上海交通大学学报,2015,35(4):559-562.
[16]李杰华,金红,杨海侠.阿替普酶与尿激酶分别联合依诺肝素钠治疗急性ST段抬高型心肌梗死的临床观察[J].中国药房,2016,27(20):2830-2833.
[17]陈华,周懿忆,戴屹东.NT-proBNP的临床应用进展[J].标记免疫分析与临床,2015,22(1):69.
[18]王魏魏,姜婷,李华,等.评价BNP NT-proBNP对心力衰竭诊断价值的Meta分析[J].中国急救医学,2015,35(5):418-425.
[19]顾永丽,孙增先.阿司匹林抵抗与氯吡格雷抵抗的研究进展[J].中国医院药学杂志,2016,36(10):866-869.
[20]唐世玲,张剑波,高志胜,等.替格瑞洛与氯吡格雷对急性心肌梗死患者经皮冠脉介入联合血栓抽吸术后炎症因子的影响[J].中国中西医结合急救杂志,2018,25(1):40-42.
[21]张华,张茁.小剂量阿司匹林对脑血管病患者血清脂蛋白(a)的作用[J].北京医学,2018,30(2):65-67.
[22]陈传良.动脉粥样硬化患者检测Lp(a)、hs-CRP、D-Dimer的临床意义[J].中国实验诊断学,2018,22(7):1168-1169.
[23]温文慧,匡泽民,王绿娅.重新认识脂蛋白(a)促进动脉粥样硬化性心血管疾病的作用[J].临床检验杂志,2018,36(3):190-192.
[24]Stoppini M,Bellotti V.Systemic amyloidosis:lessons fromβ2-microglobulin[J].J Biol Chem,2015,290(16):9951-9958.
[2]Jessup M,Antman E.Reducing the risk of heart attack and stroke:the American Heart Association/American College of Cardiology prevention guidelines[J].Circulation,2014,130(6):48-50.
[3]Sahlén A,Varenhorst C,Lagerqvist B,et al.Outcomes in patients treated with ticagrelor or clopidogrel after acute myoca rdial infarction:experiences from SWEDEHEART registry[J].Eur Heart J,2016,37(44):3335-3342.
[4]Stienen S,Salah K,Moons AH,et al.NT-proBNP(N-Terminal pro-B-Type natriuretic peptide)-guided therapy in acute decompensated heart failure:Prima II randomized controlled trial.can Nt-Probnp-Guided therapy during hospital admission for acute decompensated heart failure reduce mortality and readmissions?[J].Circulation,2018,137(16):1671-1683.
[5]赵伟林,杨帆,员丽培,等.血清同型半胱氨酸及脂蛋白(a)与冠心病的相关性研究[J].中国循证心血管医学杂志,2015,7(2):229-231.
[6]张潇伊,林瑾仪,彭娟,等.β2微球蛋白的升高在急性心梗中预测死亡风险的临床意义[J].老年医学与保健,2017,23(23):484.
[7]Anderson JL,Adams CD,Antman EM,et al.2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(23):179-347.
[8]Yap J,Lim FY,Gao F,et al.Correlation of the new york heart association classification and the 6-minute walk distance:Asystematic review[J].Clin Cardiol,2015,38(10):621-628.
[9]Jangaard N,Sarkisian L,Saaby L,et al.Incidence,frequency,and clinical characteristics of Type 3 myocardial infarction in clinical practice[J].Am J Med,2017,130(7):9-14.
[10]冯刚.经皮冠状动脉介入治疗与溶栓治疗急性ST段抬高STEMI的疗效比较[J].心脑血管病防治,2015,15(3):227-228.
[11]杨洪清,罗飏,马俊,等.静脉溶栓治疗后不同抗血小板治疗时机对急性缺血性卒中患者凝血功能及预后影响的对比研究[J].实用心脑肺血管病杂志,2018,26(1):64-67.
[12]Zerva K,Sanidas E,Tzanis G,et al.Effect of thrombolytic therapy in plaque inflammation and structural remodeling in acute myocardial infarction patients[J].Hellenic J Cardiol,2017,58(6):446-449.
[13]刘浙波,夏豪,童随阳,等.阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死疗效与安全性的Meta分析[J].疑难病杂志,2015,14(2):191-195.
[14]Lanas A,Gargallo CJ.Management of low-dose aspirin and clopidogrel in clinical practice:a gastrointestinal perspective[J].J Gastroenterol,2015,50(6):626-637.
[15]刘华,关韶峰,倪幼方.依诺肝素和普通肝素对不稳定心绞痛及非ST段抬高心肌梗死患者外源性凝血系统和血小板活性的影响[J].上海交通大学学报,2015,35(4):559-562.
[16]李杰华,金红,杨海侠.阿替普酶与尿激酶分别联合依诺肝素钠治疗急性ST段抬高型心肌梗死的临床观察[J].中国药房,2016,27(20):2830-2833.
[17]陈华,周懿忆,戴屹东.NT-proBNP的临床应用进展[J].标记免疫分析与临床,2015,22(1):69.
[18]王魏魏,姜婷,李华,等.评价BNP NT-proBNP对心力衰竭诊断价值的Meta分析[J].中国急救医学,2015,35(5):418-425.
[19]顾永丽,孙增先.阿司匹林抵抗与氯吡格雷抵抗的研究进展[J].中国医院药学杂志,2016,36(10):866-869.
[20]唐世玲,张剑波,高志胜,等.替格瑞洛与氯吡格雷对急性心肌梗死患者经皮冠脉介入联合血栓抽吸术后炎症因子的影响[J].中国中西医结合急救杂志,2018,25(1):40-42.
[21]张华,张茁.小剂量阿司匹林对脑血管病患者血清脂蛋白(a)的作用[J].北京医学,2018,30(2):65-67.
[22]陈传良.动脉粥样硬化患者检测Lp(a)、hs-CRP、D-Dimer的临床意义[J].中国实验诊断学,2018,22(7):1168-1169.
[23]温文慧,匡泽民,王绿娅.重新认识脂蛋白(a)促进动脉粥样硬化性心血管疾病的作用[J].临床检验杂志,2018,36(3):190-192.
[24]Stoppini M,Bellotti V.Systemic amyloidosis:lessons fromβ2-microglobulin[J].J Biol Chem,2015,290(16):9951-9958.