远端缺血预处理对经皮冠状动脉介入治疗术后心肌损伤及炎症反应的影响
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摘要
目的研究远端缺血预处理(RIPC)对经皮冠状动脉介入治疗(PCI)术后心肌损伤及炎症反应的影响。方法本研究为一项前瞻、随机、对照的单中心研究,选取牡丹江附属红旗医院2016年10月至2017年08月诊断为STEMI患者并成功行急诊PCI治疗的60例患者作为研究对象,随机数字表法分为预处理组(n=30)和对照组(n=30)。远端缺血预处理组在行PCI治疗前给予患者3个2min缺血/2min再灌注循环处理,对照组不作处理。两组均在术前及术后24h测血清CK-MB,c Tn I和hs-CRP水平的含量情况。结果远端缺血预处理组患者术后CK-MB,c Tn I和hs-CRP水平较对照组降低,有统计学差异(P<0.05)。结论远端缺血预处理可降低PCI术后心肌损伤及炎症反应。
Objective To investigate the effects of remote ischemic preconditioning on myocardial injury and inflammatory response after percutaneous coronary intervention( PCI). Methods This was a single center,prospective,randomized,controlled study.Sixty STEMI patients fro-m October 2016 to July 2017 were enrolled in the Mudanjiang Hongqi hospital and they we are divided into t-wo groups equally and randomly: RIPC group and non RIPC group. All the STE-MI patients were received PCI treatment. Ischemia is induced by three cycles of inflation of a blood pressure cuff placed on the left lower limb to 200 mm Hg and then deflation to 0 mm Hg for another 2 min before PCI therapy or control( an uninflated cuff around the arm). CK-MB,c Tn I and hs-CRP levels were measured prior to PCI and at 24 hours after PCI bet-ween the two groups. Results The levels of CK-MB,c Tn I and hs-CRP in the remote ischemic preconditi-oning group were lower than those in the control group,with statistical difference( P < 0. 05). Conclusion Remote ischemic preconditioning can reduce the myocardial injury and inflam-matory response after PCI.
Objective To investigate the effects of remote ischemic preconditioning on myocardial injury and inflammatory response after percutaneous coronary intervention( PCI). Methods This was a single center,prospective,randomized,controlled study.Sixty STEMI patients fro-m October 2016 to July 2017 were enrolled in the Mudanjiang Hongqi hospital and they we are divided into t-wo groups equally and randomly: RIPC group and non RIPC group. All the STE-MI patients were received PCI treatment. Ischemia is induced by three cycles of inflation of a blood pressure cuff placed on the left lower limb to 200 mm Hg and then deflation to 0 mm Hg for another 2 min before PCI therapy or control( an uninflated cuff around the arm). CK-MB,c Tn I and hs-CRP levels were measured prior to PCI and at 24 hours after PCI bet-ween the two groups. Results The levels of CK-MB,c Tn I and hs-CRP in the remote ischemic preconditi-oning group were lower than those in the control group,with statistical difference( P < 0. 05). Conclusion Remote ischemic preconditioning can reduce the myocardial injury and inflam-matory response after PCI.
引文
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[9]CHEUNG M M,KHARBANDA R K,KONSTANTINOV I E,et al.Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery:first clinical application in humans[J].J Am Coll Cardiol,2006(47):2277-2282.
[10]周发展,刘即芳,尹鲁骅,等.远端缺血预处理对经皮冠状动脉介入治疗相关心肌损伤及预后的影响[J/CD].中华临床医师杂志:电子版,2014,8(17):3068-3072.
[11]JOHNSEN J,PRYDS K,SALMAN R,et al.The remote ischemic preconditioning algorithm:effect of number of cycles,cycle duration and effector organ mass on efficacy of protection[J].Basic Research in Cardiology,2016,111(2):1-10.
[12]ZOGRAFOS T A,KATRITSIS G D,TSIAFOUTIS I,Bourboulis N,Katsivas A,Katritsis DG(2014)Effect of onecycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention[J].Am J Cardiol 113:2013-2017.doi:10.1016/j.amjcard,2014(3):43.
[2]MORAN A E,FOROUZANFAR M H,ROTH G A,et al.The global burden of ischemic heart disease in 1990 and 2010:the Global Burdenof Disease 2010 study[J].Circulation,2014,129:1493-1501.
[3]STONE G W,SELLER H P,THIELE H,et al.Relationship between infarct size and outcomes following primarypci:patient-level analysis from 10 randomized trials[J].J Am Coll Cardiol,2016.67:1674-1683.doi:10.1016/j.jacc.2016.01.069.
[4]BELL R B,TKER H,CARR R,et al.9th Hatter Biannual Meeting:position document on ischaemia/reperfusion injury,conditioning and the ten commandments of cardioprotection[J].Basic Res Cardiol,2016,111:1e13.
[5]BULLUCK H,YELLON D M,HAUSENLOY D J.Reducing myocardial infarctsize:challenges and future opportunities[J].Heart,2016,102:341-348.
[6]HAUSENLOY D J,BOTKER H E,ENGSTROM T,ERLINGE D,et al.Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction:trialsand tribulations[J].Eur Heart J,2016,5:104-106.
[7]HEUSCH G,GERSH B J.The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion:a continual challenge[published online ahead of print April 26,2016[J].Eur Heart J.doi:10.1093/eurheartj/ehw224.
[8]PRZYKLENK K,BAUER B,OVIZE M,et al.R-egional ischemic“preconditioning”protects remotevirgin myocardium from subsequent s-ustained coronary occlusion[J].Circulation,1993(87):893.
[9]CHEUNG M M,KHARBANDA R K,KONSTANTINOV I E,et al.Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery:first clinical application in humans[J].J Am Coll Cardiol,2006(47):2277-2282.
[10]周发展,刘即芳,尹鲁骅,等.远端缺血预处理对经皮冠状动脉介入治疗相关心肌损伤及预后的影响[J/CD].中华临床医师杂志:电子版,2014,8(17):3068-3072.
[11]JOHNSEN J,PRYDS K,SALMAN R,et al.The remote ischemic preconditioning algorithm:effect of number of cycles,cycle duration and effector organ mass on efficacy of protection[J].Basic Research in Cardiology,2016,111(2):1-10.
[12]ZOGRAFOS T A,KATRITSIS G D,TSIAFOUTIS I,Bourboulis N,Katsivas A,Katritsis DG(2014)Effect of onecycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention[J].Am J Cardiol 113:2013-2017.doi:10.1016/j.amjcard,2014(3):43.