替格瑞洛联合阿托伐他汀和阿司匹林对急性ST段抬高型心肌梗死PCI术后心肌血流灌注的影响

Effect of ticagrelor combined with atorvastatin and aspirin on myocardial perfusion after PCI in acute ST-segment elevation myocardial infarction

目的探讨替格瑞洛联合阿托伐他汀和阿司匹林对急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入术(PCI)术后心肌血流灌注的影响,为其临床诊治提供参考。方法选择2015年5月—2019年3月郑州市第一人民医院收治的100例行PCI手术的STEMI的患者作为研究对象,按照治疗方法将患者分为对照组和观察组,各50例。对照组口服阿托伐他汀钙片,20 mg/次,1次/d;阿司匹林肠溶片,100 mg/次,1次/d。观察组患者在对照组治疗基础上口服替格瑞洛片,180 mg/次为初始剂量,之后90 mg/次,2次/d。共治疗2个月,随访半年。比较两组患者PCI术后即刻冠状动脉血流及心肌血流灌注指标,分析两组患者住院期间及随访6个月的心功能指标及主要不良心血管事件(MACE)。比较两组患者治疗前后血清心肌肌钙蛋白I(cTnI)、血管性血友病因子(vWF)、肌酸激酶同工酶(CK-MB)及血管内皮生长因子(VEGF)水平变化。结果治疗后,观察组患者PCI术后ST段回落率、TIMI血流分级3级以及TMPG3级患者均明显高于对照组,而cTFC值比对照组降低(P<0.05)。两组患者治疗后LVEF、E/A明显升高,LVEDD明显降低(P<0.05);且观察组患者治疗后上述指标改善更为显著(P<0.05)。治疗后,两组患者的血清CK-MB水平明显降低,血清VEGF、vWF及cTnI水平均明显升高(P<0.05)。治疗后,观察组患者CK-MB水平显著低于对照组,VEGF、vWF和cTnI水平显著高于对照组(P<0.05)。观察组住院期间及术后随访MACE发生率低于对照组(P<0.05)。结论替格瑞洛联合阿托伐他汀和阿司匹林可以更好改善PCI术后STEMI患者的凝血纤溶系统和心肌血流灌注,保护心功能,减少预后MACE事件的发生率,具有一定的临床应用价值。

Objective To explore the effect of ticagrelor combined with atorvastatin and aspirin on myocardial blood perfusion after PCI in acute ST-segment elevation myocardial infarction(STEMI),and provide a reference for its clinical diagnosis and treatment.Methods A total of 100 STEMI patients who underwent PCI surgery in Zhengzhou First People’s Hospital from May 2015 to March 2019 were selected as the research subjects.According to the treatment methods,the patients were divided into control group and observation group,with 50 cases in each group.Patients in the control group were po administered with Atorvastatin Calcium Tablets,20 mg/time,once daily,and Aspirin Enteric-coated Tablets,100 mg/time,once daily.Patients in the observation group were po administered with Ticagrelor Tablets on the basis of control group,180 mg/time as the initial dose,followed by 90 mg/time,twice daily.The patients were treated for two months and followed up for six months.The indexes of coronary blood flow and myocardial blood perfusion immediately after PCI were compared between two groups,and the indexes of cardiac function and major adverse cardiovascular events(MACE)during hospitalization and 6 months follow-up were analyzed.The serum levels of cTnI,vWF,CK-MB,and VEGF were compared before and after treatment between two groups.Results After treatment,the ST segment pullback rate,TIMI grade 3 and TMPG3 patients in observation group were significantly higher than those in control group,while the cTFC value was lower than that in control group(P<0.05).After treatment,LVEF and E/A in two groups were significantly increased,while LVEDD was significantly decreased(P<0.05).The above indexes in the observation group were improved more significantly after treatment(P<0.05).After treatment,the serum CK-MB level in two groups was significantly decreased,while the serum VEGF,vWF and cTnI levels were significantly increased(P<0.05).After treatment,the level of CK-MB in observation group was significantly lower than control group,and the levels of VEGF,vWF and cTnI in observation group were significantly higher than control group(P<0.05).The incidence of MACE during hospitalization and postoperative follow-up in observation group was lower than that in control group(P<0.05).Conclusion Tagrelor combined with atorvastatin and aspirin can better improve the coagulation and fibrinolysis system and myocardial blood perfusion in STEMI patients after PCI,protect cardiac function and reduce the incidence of prognostic MACE events,which has certain clinical application value.