螺内酯对PCI术中非干预侧心肌供血的影响

The influence of spironolactone on the coronary perfusion on the non-PCI side

目的探讨螺内酯干预对经皮冠状动脉介入治疗（PCI）围手术期心肌保护作用的可能机制。方法择期PCI患者121例随机分为治疗组（A组,63例）与对照组（B组,58例）,A组在常规治疗基础上口服螺内酯20~40 mg/d,B组给予安慰剂。测定PCI非手术侧冠脉内术前与术后平均动脉压（MAP）,同时测定并比较术后血醛固酮（Ald）、肌钙蛋白I（cTn-I）、C-反应蛋白（CRP）浓度变化。分析cTn-I变化值（ΔcTn-I）与其它变量间的相关性。结果二组术后Ald、cTn-I、CRP浓度均较术前有明显升高（P〈0.05）,A组cTn-I明显低于B组（P〈0.05）;A组术后的MAP均明显高于B组（P〈0.05）;相关分析表明,ΔcTn-I与ΔCRP、ΔMAP间存在明显的相关性（r=0.61、r=0.38,P〈0.05）。结论螺内酯可增加PCI术后非手术侧冠脉的灌注;其机制可能与其能促进Ald的非基因组作用有关。

Objective To investigate the possible mechanism of spironolactone to protect myocardium during percataneous coronary intervention（PCI）.Methods A total of 121 patients undergoing PCI were randomly divided into two groups of A（63 cases,conventional therapy plus spironolactone 20-40 mg/d） and B（58 cases,conventional therapy alone）.Mean arterial pressure（MAP） of non-operated coronary artery was measured and blood aldosterone（Ald）,troponin I（cTn-I） and C-reaction protein（CRP） were detected before and after PCI.The relationship between cTn-I and other datas was analysed.Results The blood levels of Ald,cTn-I and CRP were higher after PCI than those before in two groups（P0.05）,which were higher in group A than those in group B（P0.05）.The level of cTn-I in group A was lower than that in group B（P0.05）.The MAP in group A was higher than that in group B（P0.05）.The ΔcTn-I was positively correlated to ΔCRP and ΔMAP（r=0.61 and r=0.38,P0.05）.Conclusion Spironolactonec could improve the perfusion of non-operated coronary artery in the patients uderwent PCI,which may be related with its non-genomic effects of Ald.