冠脉内注射替罗非班和尿激酶对急诊PCI时心肌微循环作用的对比研究

Comparative effects of intracoronary tirofiban versus urokinase on myocardial reperfusion in patients with STEMI undergoing primary PCI

目的:比较急性ST段抬高心肌梗死(STEMI)患者直接PCI时,冠脉内推注血小板GPⅡb/Ⅲa受体抑制剂替罗非班和溶栓剂尿激酶的疗效及安全性。方法:41例急性STEMI并接受直接PCI患者随机给予冠脉注射替罗非班(A组,n=21)或尿激酶(B组,n=20)。测定PCI时梗死相关动脉TIMI血流、校正TIMI计帧数(cTFC)、主动脉及冠状窦血清CD40L、SAA、P-selectin、vWF水平、术后2h心电图ST段回落程度、7d左室射血分数、住院天数及30d心血管事件和出血并发症。结果:A组PCI后即刻TIMI血流≥2级和cTFC及术后2h ST段回落程度明显优于B组。冠状窦血清P-选择素(P-selectin)、血管性血友病因子(vWF)、CD40L及血清淀粉样蛋白(SAA)水平在A组明显下降(P<0.05),而在B组SAA及CD40L水平有上升趋势(P>0.05)。两组术后7d左室射血分数、住院天数及30d预后和出血并发症无显著差异。结论:STEMI直接PCI时,冠脉内推注替罗非班通过抑制血小板活化和炎症因子释放,更有效改善心肌微循环再灌注。

Objective： To compare the efficacy and safety of intracoronary tirofiban versus urokinase during primary PCI in patients with acute ST-elevation myocardial infarction （STEMI）. Methods：41 patients with STEMI were randomly allocated to receive intracoronary tirofiban （Group A, n = 21） or urokinase （Group B, n = 20）. TIMI flow grade, corrected TIMI frame count （cTFC） and aortic and coronary sinus CD40L, serum amyloid A（SAA）,P-selectin, and vWF were determined during the procedure, and ST-segment resolution （STR） were measured 90 min after the PCI. Left ventricular ejection fraction （LVEF）, hospital stay, 30-day outcome, and hemorrhagic complications were recorded. Results..TIMI flow grade ≥2 and cTFC were greater during PCI and STR at 90rain after the procedure was higher in Group A than in Group B. Serum levels of P-selectin, vWF, CD40L and SAA in the coronary sinus were reduced in Group A（P〈0.05）, but SAA 及 CD40Ltended to increase in Group B. LVEF, hospital stay, 30-day outcome and bleeding complications were similar in the two groups. Conclusion.- In patients with STEMI undergoing primary PCI, intracoronary tirofiban could improve myocardial reperfusion by inhibiting coronary circulatory platelet activation and inflammatory process.