螺内酯对经皮冠状动脉介入治疗围手术期的心肌保护作用

Protective effect of spironolactone on myocardium during perioperation period of percataneous coronary intervention

目的探讨螺内酯预处理对经皮冠状动脉介入治疗(PCI)围手术期的心肌保护作用。方法将如皋市人民医院心内科2007年6月至2010年12月择期PCI的患者随机分为治疗组(A组,n=116)与对照组(B组,n=121),治疗组予螺内酯口服(20～40 mg/d)进行预处理,而对照组给予安慰剂。分别测定并比较2组PCI术前、术后主动脉根部平均动脉压力(MAPA)、血醛固酮(Aldo)、血肌钙蛋白I(cTn-I)、脑钠肽(BNP)、C-反应蛋白(CRP)浓度的变化。所有数据采用SPSS 11.5软件包进行数据分析。结果 A、B两组患者在年龄、性别、手术时间、球囊扩张次数、支架植入数量等方面差异无统计学意义;组内比较,术后Aldo、cTn-I、BNP、CRP均较术前有明显升高;组间比较,术前、术后Aldo无明显差异,A组cTn-I、CRP、BNP浓度均低于B组(P<0.05),而MAPA高于B组(P<0.05);相关分析表明ΔMAPA(术后-术前)与ΔcTn-I(术后/术前)、ΔCRP(术后/术前)、ΔBNP(术后/术前)呈负相关,相关系数分别为-0.69、-0.51、-0.56(P<0.05或P<0.01)。结论螺内酯预处理可以减轻PCI围手术期相关的心肌损害、抑制炎症反应、减轻心衰,其机制可能与螺内酯预处理可以增加心肌灌注有关。

Objective To investigate the protective mechanism of spironolactone pretreatment on myocardium during perioperation period of percataneous coronary interventional（PCI）.Methods A total of 237 patients who underwent PCI during Jun.2007 to Dec.2010 in People＇s Hospital of Rugao County were included in the present study.The patients were randomly divided into two groups： treatment group（n=116） and control group（n=121）.Patients in the treatment group were given spironolactone（20-40 mg/d） and those in the control group were given placebo.The mean arterial pressure in root of aorta（MAPA）,concentrations of aldosterone,troponin I（cTn-I）,brain natriuretic peptide（BNP） and c-reaction protein（CRP） were determined before and after PCI.All the data were analyzed by SPSS 11.5 software system.Results There were no significant differences in the age,sex,operation time,times of balloon and number of stents between the two groups.The concentrations of Aldo,cTn-I,BNP and CRP were greatly increased in the two groups after operation.The concentrations of the Aldo were similar between the two groups before and after PCI;the concentrations of cTn-I,CRP and BNP in treatment group were significantly lower than those in the control group（P0.05） and the MAPA was higher than that in the control group.We also found that ΔMAPA（postoperative MAPA-preoperative MAPA） was negatively correlated with ΔcTn-I（postoperative cTn-I/preoperative cTn-I）,ΔCRP（postoperative CRP/preoperative CRP）,and ΔBNP（postoperative BNP/preoperative BNP）,with the coefficients being-0.69,-0.51 and-0.56（P0.05 or P0.01）.Conclusion Pretreatment with spironolactone can alleviate myocardial injury,inhibit inflammatory reaction and relieve heart failure in perioperative period of PCI,which might be related to spironolactone-induced myocardial perfusion.