冠心宁注射液后处理对心肌缺血再灌注损伤保护作用的临床研究

The protective effect of Guanxinning injection post-treatment on myocardial ischemia-reperfusion injury

目的:探讨冠心宁注射液后处理对心肌缺血再灌注损伤的作用。方法:选取2016-11-2018-12陕西中医药大学附属医院收治的经冠状动脉(冠脉)造影证实的前降支近端闭塞急性心肌梗死患者168例作为研究对象,将其按随机数字表法分为Ⅰ组(常规PCI组)、Ⅱ组(缺血后适应组)与Ⅲ组(冠心宁注射液后处理组),每组56例。比较3组患者术后血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)峰值水平;比较3组患者入院时、术后6 h、术后1 w的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、丙二醛(MDA)、血清超氧化物歧化酶(SOD)以及一氧化氮(NO)水平。结果:3组患者年龄、性别、高血压病、2型糖尿病、吸烟、血脂异常、发病至首次医疗接触时间(FMC)、门-球时间(D-B)、术前血清心肌酶学、术前GRACE危险评分等差异均无统计学意义。Ⅲ组术后cTnI、CK及CK-MB峰值均低于Ⅰ组、Ⅱ组,均差异有统计学意义(均P<0.05);与Ⅰ组、Ⅱ组术后6 h、1 w比较,Ⅲ组血清IL-6、TNF-α及hs-CRP水平均显著降低,均差异有统计学意义(均P<0.05);与Ⅰ组、Ⅱ组术后6 h、1 w比较,Ⅲ组血清MDA降低,SOD、NO升高,均差异有统计学意义(均P<0.05)。结论:冠心宁注射液后处理较PCI术与缺血后适应在预防和治疗心肌缺血再灌注损伤方面更加有效,值得临床推广。

Objective:To explore the effect of Guanxinning injection post-treatment on myocardial ischemia-reperfusion injury.Method:A total of 168 patients with acute myocardial infarction with proximal anterior descending branch occlusion confirmed by coronary angiography were selected from the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from November 2016 to December 2018.All patients were divided into 3 groups according to the random number table method,with 56 cases in each group.Group I was treated with routine PCI,groupⅡwas treated with ischemic post-ischemic,and groupⅢwas treated with Guanxinning injection post-treatment.Peak levels of serum troponin I(cTnI),creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)after operation,levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),malondialdehyde(MDA),superoxide dismutase(SOD)and nitric oxide(NO)at admission,6 hours and 1 week after operation among three groups were compared.Result:There was no significant difference in age,sex,hypertension,type 2 diabetes mellitus,smoking,hyperlipidemia,time from onset to first medical contact(FMC),door-ball time(D-B),preoperative serum myocardial enzymology and preoperative GRACE risk score among three groups.Peak values of cTnI,CK and CK-MB in groupⅢwere significantly lower than those in groupⅠand groupⅡ(all P<0.05).Levels of IL-6,TNF-α,and hs-CRP 6 h and 1 w after the operation in groupⅢwere significantly decreased compared with those in groupⅠand groupⅡ(all P<0.05).Compared with groupⅠand groupⅡ,serum MDA 6 h and 1 w after the operation in groupⅢsignificantly decreased,while SOD and NO significantly increased(all P<0.05).Conclusion:The post-treatment of Guanxinning injection is more effective in preventing and treating myocardial ischemia reperfusion injury than PCI and ischemi apost-conditioning,which is worthy of clinical promotion.