应用延迟增强多层螺旋CT观察替罗非班对猪急性心肌梗死再灌注损伤的影响

Evaluation of the effects of tirofiban on myocardial infarction-reperfusion injury by delayed enhancement multi-slice spiral CT

目的应用延迟增强多层螺旋CT（DE—MSCT）评价单独应用替罗非班对猪急性心肌梗死（AMI）再灌注后无复流的影响。方法采用完全随机设计方法将中国试验用小型猪分为对照组（10只）和替罗非班组（9只）。通过介入球囊封闭冠状动脉的方法堵闭左前降支中段90min后，撤出球囊制作AMI再灌注模型。所有实验动物在AMI再灌注后1、24、48和72h进行DE—MSCT检查，观察无复流和梗死心肌面积的变化，采用Spearman秩相关和Wilcoxon秩和检验进行统计分析。结果对照组10只、替罗非班组9只实验猪成功穿刺并行冠状动脉造影。对照组和替罗非班组各6只猪的心肌梗死再灌注模型制作成功，对照组4只、替罗非班组3只实验动物DE—MSCT检查出现无复流现象。2组无复流区体积在AMI再灌注后1～72h均呈增大趋势。替罗非班组无复流体积百分比在再灌注后1～72h各时间点均小于对照组[1h分别为（4．78±0．66）％和（9．62±3．05）％；24h分别为（5．84±1．19）％和（13．44±3．33）％；48h分别为（6．41±1．24）％和（15．10±3．76）％；72h分别为（6．63±0．82）％和（15．94±4．62）％；t值均为6．000，P值均〈0．05]。梗死心肌体积百分比在再灌注后各时间点明显小于对照组[24h分别为（19．74±2．94）％和（25．08±4．68）％，t=25．000，48h分别为（20．34±2．46）％和（27．07±5．44）％，t=26．000；72h分别为（20．72±2．10）％和（26．17±5．19）％，t=24．000，P值均〈0．05]。结论DE．MSCT可以作为评估无复流的方法，替罗非班能够减小AMI再灌注后的无复流和梗死心肌范围。

Objective To evaluate the effcets of tirofihan on myocardial no-reflow after acute myocardial infarction and reperfusion by delayed enhancement-multi-slice CT （DE-MSCT） . Methods Chinese mini pigs were randomized into control group and tirofiban treatment group. Acute myocardial infarction was induced by balloon occlusion of the medium segment of the left anterior descending artery for 90 minutes. Reperfusion was created by withdrawing the balloon during anglography. All successful models received DE-MSCT examinatons at 1 h, 24 h, 48 h, and 72 h after reperfusion to observe the myocardial no-reflow area. Data were analyzed with Spearman rank correlation and Wilcoxon Rank Sum test. Results Six pigs were successfully induced as acute reperfusion myocardial infarction in each group. Furthermore ,4 pigs in control group and 3 pigs in tirofiban treatment group had no-reflow phenomenon. The no-reflow volume percent increased from 1 h to 72 h in both groups. The no-reflow volume percent was significantly reduced in tirofiban treatment group compared with control group after reperfusion at 1 h, 24 h, 48 h and 72 h respectively[（4.78 ±0.66）% and （9.62 ± 3.05）%, t = 6.000, P 〈0.05; （5.84 ± 1.19）% and （13.44 ±3.33）%,t=6.000,P〈0.05;（6.41±1.24）% and （15.10±3.76）%,t=6.000,P〈0.05; （ 6. 63 ± 0. 82 ） % and （ 15.94 ± 4. 62 ） %, t = 6. 000, P 〈 0.05 ], as well as the infarct myocardium volume percent was significantly reduced in tirofiban treatment group compared with control group at 24 h, 48 h and 72 h after reperfusion [ （ 19. 74 ± 2.94） % and （ 25.08 ± 4. 68 ） %, t = 25. 000, P 〈 0. 05 ; （ 20. 34 ± 2. 46） % and （27.07 ±5.44）%, t =26. 000,P 〈0. 05;（20. 72 ±2. 10）% and （26. 17 ±5.19）% ,t =24.000,P〈 0. 05 ]. Conclusions DE-MSCT can be used to detect the extent of no-reflow phenomenon. Tirofiban can reduce the volume of myocardial infarct and no-reflow area after reperfusion.