替罗非班对急性心肌梗死择期介入治疗患者血流灌注及心功能的影响

Effect of Tirofiban hydrochloride on coronary perfusion and cardiac function in patients with acute myocardial infarction underwent elective percutaneous coronary intervention

目的观察替罗非班对急性sT段抬高型心肌梗死（STEMI）择期接受冠状动脉介入治疗（PCI）患者冠状动脉血流及心功能恢复的影响。方法选取STEMI未及时行冠状动脉再通治疗，且仍有心绞痛发作的患者56例，完全随机分为研究组和对照组，各28例。2组均接受常规药物治疗。研究组在此基础上加用替罗非班注射液。于梗死后10—14d行PCI术。术中测定心肌梗死溶栓试验（TIMI）血流分级、TI-MI心肌灌注分级（TMPG）、血小板聚集率和血清可溶性细胞间黏附分子-1（sICAM-1）水平；术后4周测定室壁运动记分（WMSI）；观察2组患者出血发生率及30d主要心血管事件（MACE）发生率。结果PCI术前研究组TIMI血流分级2—3级者11例（39．3％），高于对照组的6例（21．4％），差异有统计学意义（P〈0．05）。PCI术前和术后研究组TMPG分级2—3级的例数[分别为9例（32．2％）、24例（85．8％）]均高于对照组[分别为3例（10．7％）、17例（60．7％）]，差异有统计学意义（P〈0．05）。研究组sICAM-1浓度[治疗前及治疗后24、72h分别为（457．79±65．70）、（287．67±33．75）、（190．16±47．32）ng／L]较对照组[治疗前及治疗后24、72h分别为（463．25±59．60）、（335．41±43．60）、（278．22±39．05）ng／L]明显降低，且较自身治疗前也有明显下降，差异有统计学意义（均P〈0．05）。研究组出血发生率[64．3％（18／28）]高于对照组[35．7％（10／28）为，但差异无统计学意义（P〉0．05）。2组患者均未见明显血小板减少。术后30d研究组MACE发生率为10．7％（3／28），对照组MACE发生率为35．7％（10／28），组间差异有统计学意义（P〈0．05）。结论替罗非班可以明显改善冠状动脉PCI靶血管前向血流，改善心功能及患者预后。

Objective To observe the effect of tirofiban hydrochloride on coronary perfusion, platelet aggression ratio and prognosis in patients with acute ST-elevation myocardial infarction （STEMI） undergoing elective percutaneous coronary intervention （PCI）. Methods Fifty-six patients with acute STEMI who underwent elective PCI were randomized to the tirofiban group and the control group. Thrombolysis in myocardial infarction（TIMI） flow grade, the TIMI myocardial perfusion grade （TMPG）, platelet aggression ratio, the levels of soluble intercellular adhesion molecule （sICAM-1）, heart wall motion score index （WMSI）, bleeding rate and the risk for major adverse cardiac events （MACE） were observed. Results The TIMI flow grade before PCI, TMPG before and after PCI in patients of tirofiban group were higher than those in the control group. The sICAM-1 levels of tirofiban group after 24 h and 72 h were much lower than these in control group. The rate of MACE and WMSI of tirofiban group [ 10.7% （3/28） and （ 1.20 ±0.22） ] were lower than those of the control group [ 35.7 % （10/28） and （ 1.35 ±0.26） ] （ all P 〈 0.05）. Conclusion Tirofiban is associated with reinforced antiplatelet treatment improved target artery patency, myocardial perfusion as well as cardiac function among patients with STEMI undergoing elective PCI.