别嘌醇预处理对经皮冠状动脉介入治疗围手术期心肌损伤的影响

Peri-procedural myocardial injury impact of allopurinol pretreatment in patients with undergoing PCI

目的：探讨别嘌醇预处理对经皮冠状动脉介入（PCI）治疗患者围手术期心肌损伤的保护作用。方法：选取246例拟择期行PCI的患者,随机分为试验组（124例）和对照组（122例）,两组患者均予以冠心病标准化药物治疗,试验组在标准化药物治疗基础上给予别嘌醇顿服300mg/d（术前至少连续口服3d）,术后100mg/d维持。术后8~24h测定肌酸激酶同工酶（CK-MB）、肌钙蛋白T（cTnT）、C反应蛋白（CRP）、肝功能、肾功能、血常规。结果：试验组PCI术后CK-MB和cTnT超过正常上限的发生率分别为6.5%和10.5%,显著低于对照组的发生率21.3%和38.5%（均P〈0.05）。试验组PCI术后CRP超过正常上限的发生率为11.3%,低于对照组的发生率23.0%（P〈0.05）。试验组别嘌醇治疗期间有1例患者因皮疹而退出,余治疗结束时肝功能、肾功能、血细胞情况等均无明显改变,未发现明显严重不良反应。结论：300mg/d常规剂量别嘌醇预处理可显著减少择期PCI患者围手术期心肌损伤。

Objective：To investigate potential protective effects of allopurinol pretreatment in patients with undergoing elective percutaneous coronary intervention（PCI）.Method：A total of 246patients with undergoing elective PCI were randomized to pretreatment with allopurinol（300mg/d at least 3days before the procedure.n= 124,with a maintenance dosage 100mg/d after PCI）,or placebo（n=122）.All patients without contraindications were pretreated standard medical therapy.Creatine kinase-MB（CK-MB）,troponin T（cTnT）,C-reactive protein（CRP）levels,and liver function,renal function and routine blood test were measured at baseline and at 8to 24 hours after the procedure.Result：The primary end point occurred in the proportion of patients of postoperative CKMB over upper limits of normal,and cTnT positive in experimental group were 6.5%and 10.5%,lower than that in control group 21.3%and 38.5%（both P0.05）.The secondary end points of the rise of postoperative CRP levels in experimental group was 11.3%,lower than that in control group 23.0%（P0.05）.There were no cytopenia,dermatitis,abnormal liver function or renal dysfunction in experimental group,but only one drop out because of rash reaction until the end of treatment.Conclusion：Taking allopurinol（300 mg/d）pretreatment in patients with undergoing elective PCI is effective,and may reduce incidence of postoperative myocardial damage.