介入时机与西洛他唑对非ST段抬高型心肌梗死后左心室重构的影响

Effect of percutaneous coronary intervention timing and cilostazol use on left ventricular remodeling in patients with non-ST elevation myocardial infarction

目的 探讨非ST段抬高型心肌梗死（NSTEMI）后血浆基质金属蛋白酶（MMP）的变化及经皮冠状动脉介入治疗（PCI）时机、西洛他唑对NSTE MI后左心室重构的影响.方法 连续入选行PCI的NSTEMI患者189例,将其中成功随访的164例患者纳入研究.患者分为早期PCI联合西洛他唑组（A组）、早期PCI组（B组）、延迟PCI联合西洛他唑组（C组）和延迟PCI组（D组）.检测各组患者心肌梗死后不同时间血浆MMP-2及MMP-9水平.患者于入院时及PCI术后1年行超声心动图检查.结果 （1）NSTEMI后2 d、4 d、2周和4周,MMP-2水平均为A组低于B组,C组低于D组（均P＜0.05）.NSTEMI后4 d、2周和4周,MMP-9水平均为A组低于B组,C组低于D组（均P＜0.05）.（2）随访1年显示,左心室舒张末期容积和左心室射血分数的变化值均为A组低于B组,C组低于D组,B组低于D组（P＜0.05或P＜0.01）.左心室缩短分数、左心室舒张末期内径、左心室后壁厚度、室间隔厚度变化值各组间差异均无统计学意义.结论 早期介入治疗及西洛他唑可以改善左心室重构,西洛他唑对左心室重构的影响可能与抑制MMP有关.

Objective To observe the dynamic changes of plasma matrix metalloproteinases （MMPs） and investigate the effect of early or delayed percutaneous coronary intervention （PCI） in the presence or absence cilostazol on left ventricle （LV） remodeling in patients with non-ST elevation myocardial infarction （NSTEMI）. Methods One hundred and sixty-four patients undergoing PCI with NSTEMI were randomized to early PCI （PCI within 24 h） group or delayed PCI group （PCI after 36 h）, and patients in both group were further assigned to cilostazol or no cilostazol group. Plasma MMP-2 and MMP-9concentrations were measured at 2, 4 days and 2 and 4 weeks after PCI. Left ventricular end-diastolic volume （ LVEDV ）, left ventricle ejection fraction （ LVEF）, left ventricle posterior wall （ LVPW ） and interventricular septum （IVS） were measured by echocardiography at baseline and 1 year after PCI. Results MMP-2 concentration at 2 weeks after PCI is higher than that at 2, 4 days and 4 weeks after PCI. MMP-9concentration at 4 days is higher than that at 2 days, 2 weeks and 4 weeks after PCI. MMP-2 and MMP-9were significantly lower in cilostazol group compared with that in non-cilostazol group at 4 days, 2 weeks and 4 weeks after NSTEMI （ all P 〈 0. 05 ）. Changes of LVEDV and LVEF were significantly less in cilostazol group and early PCI group than that in no cilostazol group and delay PCI group （P〈0.05 or P〈0. 01） at 1year after NSTEMI. Conclusions Early PCI and Cilostazol use are associated with less LV remodeling in patients with NSTEMI. Cilostazol attenuated LV remodeling possibly by reducing concentration of MMP-2and MMP-9 after PCI.