国产替罗非班对急性心肌梗死患者急诊介入治疗术后冠状动脉血流和心肌灌注影响的研究

Effect of Tirofiban on Recovery of Coronary Flow and Myocardial Blush Perfusion in Patients With Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

目的：急性心肌梗死患者急诊直接经皮冠状动脉(冠脉)介入治疗(PCI)术中应用国产血小板糖蛋白Ⅱb/Ⅲa 受体拮抗剂替罗非班,评价替罗非班对术后冠脉血流和心肌灌注的影响。方法：2004年8月～2005年5月,共50例接受急诊直接 PCI 治疗的急性心肌梗死患者纳入研究,其中男性34例,女性16例,年龄43～73(60.2±19.1)岁,随机分为替罗非班组和对照组,两组各25例。比较两组间的基础临床状况、造影情况、介入治疗结果以及住院期间随访情况,术后即刻对病变血管行心肌梗死溶栓治疗临床试验(TIMI)分级、计算校正的 TIMI 计帧数和心肌 Blush 分级。结果：两组一般情况、基础临床情况和造影、介入资料均无显著性差异(P＞0.05)。术后 TIMI 3级获得率未见显著性差异(96%和88%,P＞0.05),但替罗非班组的校正的 TIMI 计帧数明显低于对照组(22.8±8.9帧和30.9±3.4帧,P ＜0.05)；而 Blush 3级获得率则显著高于对照组(72.0%和32.0%,P＜0.01)。同时,替罗非班组术后肌酸激酶峰值浓度较对照组低[(1862.9±301.0)IU/L 和(2302.3±582.6)IU/L,P＜0.05],术后90分钟心电图相关导联 ST 段回落幅度较对照组大[(63.2±13.3)%和(40.9±12.9)%,P＜0.05]。两组住院期间主要心血管事件发生率无显著性差异(P ＞0.05)。替罗非班组出血发生率高于对照组,但无统计学意义(P＞0.05)。结论：初步研究表明,急性心肌梗死患者急诊直接 PCI 术中联合应用国产替罗非班是安全的,可以改善 PCI 术后的冠脉血流和心肌灌注,其对临床结果的影响值得进一步研究。

Objective： To investigate the effect of glycoprotein llb/llla receptor blockade with tirofiban on coronary flow and myocardial blush perfusion recovery in patients with acute myocardial infarction （AMI） treated by primary percutaneous coronary intervention （PCI）. Methods： With mean age of 60. 2 ± 19. 1 years old, 50 patients （34 males） with first AMI were randomized to receive either tirofiban and primary PCI （ n = 25 ） or primary PCI alone （ n = 25 ）. Baseline characteristics of the two groups were compared. TIMI grade, Corrected TIMI frame count （CTFC） and myocardial blush grade were studied immediately after P-PCI. Results： There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI （P 〉0. 05）. There was no difference between the two groups in percentage of TIMI 3 flow achieved in IRAs after PCI （96% vs 88%, P 〉 0. 05 ）. Fewer TIMI frames （22. 8 ± 8. 9 frames vs. 30. 9 ± 3.4 frames, P 〈 0. 05 ） and higher percentage of blush grade 3 of IRAs （72.0% vs 32. 0%, P 〈0.01 ） were achieved in tirofiban group. Follow-up data before discharge showed there were lower peak serum CK levels （ 1862. 9 ± 301.0 IU/L vs 2302. 3 ± 582.6 IU/L, P 〈 0. 05） and faster ST segment resolutionin the tirofiban group after PCI （63.2 ± 13.3% vs 40. 9 ± 12.9%, P 〈0.05）. There was no significant difference between the two groups in occurrence of MACE or bleeding in both groups （P 〉 0.05）. Conclusions ： Application of tirofiban during primary PCI in patients with AMI was safe and effective, which improves microvascular perfusion, and further study is necessary to reveal the real effect of tirofiban on clinical results in AM1 patients treated by primary PCI.