通心络对急性心肌梗死患者再灌注后心肌和微血管的保护性研究

The protective effects of Tong-xin-luo on myocardium and microvasculature after reperfusion in acute myocardial infarction

目的观察通心络胶囊对急性心肌梗死(AMI)接受经皮冠状动脉介入治疗(PCI)或溶栓治疗后患者心肌和微血管保护作用和可能产生的机制。方法对我院收治的ST段抬高的AMI患者,成功实施PCI或溶栓治疗的患者,随机分为常规药物治疗作为对照组(52例)和同时加服用通心络胶囊的治疗组(60例)。于发病后不同时间连续观察多普勒二维超声心动图(2DE)的室壁异常节段恢复状态、左室舒张末容积(LVEDV)、左室射血分数(LVEF)改变,并于6个月时与同位素心肌显像结果进行对照分析。结果冠状动脉血管重建后(1)在通心络组中,1周、2周和1个月时异常室壁运动节段恢复率(分别为11.7%,18.1%和18.8%)较对照组明显高(分别为4.1%,8.3%和11.1%)(均P<0.05);6个月时通心络组的总恢复率高达70.0%,也明显高于对照组的51.7%。(2)1周、2周和1个月时通心络组LVEDV与对照组容积增加比率相当(均P>0.05);3个月和6个月时通心络组LVEDV增加比率较对照组明显降低(均P<0.01)。(3)治疗初,通心络组LVEF与对照组相当(P>0.05);治疗后1周、2周和1个月时两组间差异无统计学意义(均P>0.05);3个月时和6个月时,通心络组恢复明显高于对照组(P<0.01和0.05)。(4)2DE的左心室室壁节段运动评分指数(WMSI)治疗初通心络组与对照组间差异无统计学意义(P>0.05);6个月时,通心?

ObjectiveTo evaluate the protective effects of Tongxinluo on myocardium and microvasculature after reperfusion in patients with acute myocardial infarction. MethodsThe research was performed on the patients with AMI whose initial ECG showed ST segment elevation and the patients received PCI or thrombolysis immediately after onset. These patients were classified randomly into two groups: control group in which the patients were given routine drug treatment (52 cases) and treatment group in which the patients were given routine drug plus Tongxinluo capsule (60 cases). We observed the abnormal movement of the ventricle wall in 2DE, and the change in LVEDV or LVEF on the 1st day, 7 th day, 13 th day, 3 rd month, and 6 th month after onset, which were compared with the result of DISA and SPECT for myocardial image. At the same time we also examined the blood NO and MDA levels on the 1st day, the 7 th day and 13 th day.Results(1)The recover rate for the abnormal movement of the ventricle segments in the treatment group were 11.86%,18.12% and 18.79% respectively, which were higher than that of the control group (4.13%,8.27% and 11.11% respectively) on the 1st week, the 2nd week, and the 1st month. At the 6 th month the total recover rate for the abnormal movement of the ventricle segments of Tongxinluo group was 70.03%, which was significantly higher than that of the control group (51.68%). The WMSI was also decreased more than that of the control group.(2) The LVEDV in Tongxinluo group increased by 9.42% one week after onset, which was close to that of the control group (9.59%). There was no significant change (9.40% and 9.42% respectively) after two weeks and one month in Tongxinluo group, whereas it was increased continuously in the control group (11.84% and 12.33%). LVEDV in Tongxinluo group was decrease obviously after three and six months (3.62% and 5.07% respectively), which was close to the original level, whereas the result of the control group remained on a higher level (13.70% and 11.72% respectively). (3) LVEF of the Tongxinluo group was 53.32% before treatment, which was comparable with that of the control group (P=0.45). There was no significant difference between the two groups after treatment for 1 week, 2 week and 1 month (P=0.11,P=0.13,P=0.18 , respectively). LVEF for the two groups was 58.27% and 53.40% respectively after three months and there was a statistical significance (P<0.01). LVEF for the two groups was 58.33% and 53.82% respectively after 6 months and the difference remained statistically significant (P<0.05). (4) The 2DE WMSI for the Tongxinluo group was 1.7552 after 12 hours to 24 hours of the CVR and there was no significant difference compared with that of the control group (WMSI=1.5380, P=0.6945). After 6 months, the WMSI decreased to 1.3767 in the Tongxinluo group, which was statistically different from that of the control group (WMSI=1.5380, P<0.01). The myocardium acquire isotope score index of the Tongxinluo group was 0.6075 at 6 months, which was significantly different from that of the control group (0.8781). (5) Ultrasonic humerus artery examination in static status showed that there was no significant difference on the diameter of blood vessel and the speed of blood stream between Tongxinluo group and control group with. The diameter of the blood vessel after artery pressure in Tongxinluo group was expanded, which was significantly different from that in the static status (P<0.001) and that in control group (P<0.001). The diameter of blood vessel after administration of nitroglycerin in both groups was expanded, which was significantly different from that in the static status (P<0.001 and P<0.05). However, Tongxinluo group was expand more obviously than that of the control group(P<0.05). (6) The MDA level of the Tongxinluo group was decreased (all P<0.05) and the NO level was increased ( all P<0.05) gradually from the 1st week to the 4 th week; however, the MDA level of the control group was not decreased until the 4th week (P<0.05), and the NO level of the control group was increased e