缺血、药物后适应及两者叠加对急性心肌梗死患者再灌注心肌的保护作用

Myocardial protective effects of ischemic postconditioning and pharmacologic pos tconditioning on elective percutaneous coronary intervention in patients with ac ute myocardial infarction

目的研究缺血后适应、药物后适应及两者叠加对择期冠脉介入(PCI)患者再灌注心肌的保护作用。方法 83例急性心肌梗死(AMI)择期行PCI的患者,随机分为四组,单纯PCI组16例,尼可地尔组21例,缺血后处理组27例及叠加组19例。尼可地尔组及叠加组在常规治疗基础上加用尼可地尔(喜格迈)5 mg治疗,缺血后处理组及叠加组在再灌注开始1 min内缺血后处理,用药1 w后行PCI。所有患者测定血肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)浓度、中性粒细胞数;术中测定校正TIMI帧数(CTFC);入院及治疗后行心脏彩超检查。结果术后24 h对照组cTnT、CK-MB水平明显高于尼可地尔组、缺血后处理组及叠加组;而尼可地尔组、缺血后处理组及叠加组之间未见统计学差异。对照组的CTFC(帧数)明显高于其他三组(31.19±2.86、26.43±1.57、27.19±1.47 vs.26.79±1.40,P<0.05),而后三组之间未见统计学差异。四组患者术前中性粒细胞数未见统计学差异,术后24 h对照组的中性粒细胞数明显高于其他三组〔(6.94±0.74)×109/L、(5.98±0.51)×109/L、(5.80±0.50)×109/L vs.(5.88±0.44)×109/L,P<0.05〕。治疗6个月后对照组LVEF明显低于尼可地尔组、缺血后处理组及叠加组,WMSI明显高于其他三组;而尼可地尔组、缺血后处理组及叠加组之间未见统计学差异。结论尼可地尔药物后适应与缺血后适应一样可以减轻心肌再灌注损伤,改善患者预后,而两者叠加未见加强作用。

Objective To explore myocardial protective effects of ischemic postconditioning and pharmacologic postconditioning on elect ive percutaneous coronary intervention in patients with acute myocardial infarct ion（AMI）. Methods 83 patients diagnosed with AMI who needed elective PCI were randomly assigned to 4 groups： control group with 16 patients,Nicorandil group with 21 patients receiv ed 5 mg peroral nicorandil third a day,Ipost group with 27 patients,Nicorandil ＋Ipost group with 19 patients.PCI was performed 1 week after treatment.Cardi ac troponin（cTnT）,creatine kinase-MB（CK-MB） were measured before and 0,12,2 4 h after PCI,neutrophilic granulocyte was measured before and 24 h after PCI,co rrected TIMI frame count（CTFC） was measured in PCI,wall motion score index（WM SI） and left ventricular ejection fraction（LVEF） were measured before and 6 mon ths after PCI. Results cTnT and CK-MB were higher 24 h after PCI,CTFC was slow er（P0.05） neutrophilic granulocyte was higher（P0.05） in control group than those of other groups.6 months later,LVEF was lower,WMSI was hig her in control group than that of other groups（P0.05）.There were no sig nificant difference between Nicorandil group,Ipost group and Nicorandil＋Ipost g roup. Conclusions Nicorandil has the similar myocardial protect ive effect with ischemic postcondit ioning during elective PCI in patients with AMI.Both of them have no enhanceme nt property on the above effect.