术前阿托伐他汀和替罗非班联合应用对老年急性心肌梗死经皮冠状动脉介入术治疗患者外周血微小RNA表达、肱动脉内径及血管内皮功能的影响

Effect of preoperative atorvastatin combined with tirofiban on expression of peripheral blood microRNA,internal diameter of brachial artery and vascular endothelial function in elderly patients with acute myocardial infarction undergoing percutaneous coron

目的探讨术前阿托伐他汀和替罗非班联合应用对老年急性心肌梗死经皮冠状动脉介入术(PCI)治疗患者外周血微小RNA(miRNA)表达、肱动脉内径及血管内皮功能的影响。方法选择老年急性心肌梗死患者70例分为研究组与对照组各35例。于PCI术前,研究组给予阿托伐他汀联合替罗非班,对照组仅给予阿托伐他汀。与给药前及PCI后,检测两组患者外周血miRNA表达水平、肱动脉内径,以及血管性假血友病因子(v WF)、内皮素-1(ET-1)、NO等内皮功能指标。结果 PCI后,两组miRNA-1、miRNA-133a、miRNA-208b及miRNA-499水平较前降低,且研究组低于对照组(P<0.05)。PCI后,两组肱动脉内径较前增大,且研究组大于对照组(P<0.05)。PCI后,两组v WF、ET-1水平较前降低,且研究组低于对照组(P<0.05);两组NO水平较前升高,且研究组高于对照组(P<0.05)。结论老年急性心肌梗死患者PCI术前采用阿托伐他汀联合替罗非班治疗,不但具有较好的抗凝、抗血小板活化作用,还能够起到较好的血管内皮保护作用,有效抑制心血管疾病的发展。

Objective To explore the effect of preoperative atorvastatin combined with tirofiban on the expression of peripheral blood microRNA（ miRNA）, internal diameter of brachial artery and vascular endothelial function in elderly patients with acute myocardial infarction（AMI） undergoing percutaneous coronary intervention （PCI）. Methods Seventy elderly, patients with AMI were selected and were divided into study group（ n = 35 ） and control group（ n = 35 ）. Before PCI, the study group was administered atorvastatin combined with tirofiban, and the control group was administered atorvastatin alone. Before administration and after PCI,the expression level of peripheral blood miRNA,internal diameter of brachial artery and vascular endothelial function including yon Willebrand factor（ vWF）, endothelin-1 （ ET-1 ） and NO were detected in the patients of both groups. Results After PCI,the levels of miRNA-1 ,miRNA-133a,miRNA-208b and miRNA-499 decreased in both groups, and the levels in the study group were lower than those in the control group （P 〈 0.05）. After PCI, the internal diameters of brachial artery in both groups were greater,and the internal diameter in the study group was greater than that in the control group （P 〈 0.05 ）. After PCI, the levels of vWF and ET-1 decreased in both groups, and the levels in the study group were lower than those in the control group;the levels of NO in both groups increased, and the level in the study group was higher than that in the control group （P 〈 0.05）. Conclusion For elderly patients with AMI, atorvastatin combined with tirofiban used before PCI not only has a good efficacy in anticoagulation and anti-platelet, but also has a good effect on protecting the vascular endothelial function, and can inhibit the progression of cardiovascular disease effectively .