丹红对ST段抬高型急性心肌梗死PCI术后心肌无复流影响及其机制

EFFECT OF DAN-HONG ON MYOCARDIAL NO-REFLOW AFTER PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFACTION AND ITS MECHANISM

目的探讨丹红对ST段抬高型急性心肌梗死经皮冠状动脉介入(PCI)术后无复流现象的影响及其可能机制。方法 ST段抬高型急性心肌梗死病人60例,随机分成PCI+丹红组(丹红组)和直接行PCI组(直接PCI组),各30例。丹红组PCI手术开始即给予丹红注射液4 mL稀释后静脉缓慢注射,然后给予丹红注射液20mL稀释后静脉滴注,维持至PCI手术结束;直接PCI组不用丹红。应用单导联ST段回落百分比、矫正的冠状动脉血流分级(TIMI)帧数计数来评估心肌再灌注情况,同时监测术前术后病人炎症因子白细胞介素-6(IL-6)的变化。结果丹红组矫正的TIMI帧数>40s的病例数显著少于直接PCI组(χ2=6.405,P<0.05),PCI术后单导联ST段回落良好(≥50%)病人例数多于直接PCI组(χ2=4.593,P<0.05);IL-6回落水平大于直接PCI组(t=2.058,P<0.05)。结论丹红可减少ST段抬高型心肌梗死PCI术后无复流现象的发生率,其机制可能是通过抑制IL-6的释放发生作用。

Objective To study the effect of Dan-hong on no-reflow phenomenon in patients with ST elevation acute my- ocardial infarction （AMI） after percutaneous coronary intervention （PCI） and its possible mechanism. Methods Sixty patients with ST elevation AMI were evenly randomized to PCI^-Dan-hong group （Dan-hong group） and PCI group. The patients in Dan- hong group were given intravenous Dan-hong injections 4 mL （to be diluted） at the beginning of PCI, and then 20 mL for intrave- nous drip, which was kept until the end of the procedure; for those in PCI group, PCI was performed only, without Dan-hong. Resolution of the single ST segment elevation （STR≥50%） after PCI, corrected TIMI frame count （CTFC） and the level of inter- leukin-6 （IL-6） after PCI were used to evaluate the degree of no-reflow. Results The CTFC （frame number 〉40 s） of Dan- hong group was significantly less than PCI group （X2 = 6. 405, P d0.05）. The STR （〉 50%） after PCI in Dan-hong group was higher than that in PCI group （Zz =4.593 ,P〈0.05）. There were significant differences between Dan-hong group and PCI group on STR. The serum levels of IL-6 after PCI in PCI group were higher than the Dan-hong group （t =2.058,P〈0.05）. Conclusion Dan-hong can reduce no reflow phenomenon in patients with AMI. The mechanism may be that through inhibiting the release of IL- 6 and thus reduce the occurrence of no reflow.