血栓抽吸术联合PCI对急性ST段抬高型心肌梗死患者血清ITLN-1水平的影响

Effect of thrombus aspiration combined with percutaneous coronary intervention on serum ITLN-1 level in patients with acute ST-segment elevation myocardial infarction

目的探讨经皮冠状动脉介入术(PCI)联合抽吸血栓与单纯常规PCI术对急性ST段抬高心肌梗死(STEMI)患者血清凝集蛋白-1 (ITLN-1)、血流灌注水平、心功能和预后的影响。方法选取2010年1月至2014年6月就诊于桂林市人民医院心内科行PCI术的STEMI患者549例,根据是否行血栓抽吸将其分为血栓抽吸联合PCI组(联合组) 381例和单纯PCI组168例。比较两组患者的术后血流TIMI分级、术后1周心功能情况[左室射血分数(LVEF)和左室舒张末期内径(LVDD)]、术后血清肌酸激酶(CK)和其同工酶(CK-MB)的峰值及ST段回落情况;酶联免疫法检测入院时、术后24 h、1周和6个月两组患者的血清ITLN-1水平,随访术后6个月发生的主要心血管不良事件。结果联合组与单纯PCI组患者入院时的血清ITLN-1水平分别为(141.5±87.2) ng/mL和(134.2±105.5) ng/mL,差异无统计学意义(P>0.05),术后24 h分别为(432.7±151.4) ng/mL和(352.9±135.3) ng/mL,术后1周分别为(338.9±141.7) ng/mL和(297.5±155.7) ng/mL,组间比较差异均有统计学意义(P<0.05),但术后6个月分别为(241.7±103.6) ng/mL和(234.8±98.6) ng/mL,组间比较差异无统计学意义(P>0.05);联合组与单纯PCI组患者无复流或慢血流发生率分别为3.9%和10.1%,CK水平分别为(1 463.4±372.6) U/L和(1 835.1±280.3) U/L,CK-MB水平分别为(163.5±42.9) U/L和(217.2±49.4) U/L,组间比较差异均有统计学意义(P<0.05);联合组与单纯PCI组患者的ST段回落≥50%的患者比例分别为86.1%和61.3%,LVDD分别为(51.5±3.2) mm和(56.1±4.1) mm,LVEF分别为(57.2±3.5)%和(53.3±4.2)%,组间比较差异均有统计学意义(P<0.05);随访6个月,联合组患者的心力衰竭发生率为6.3%,明显低于单纯PCI组的14.4%,差异有统计学意义(P<0.05),而再次心肌梗死、恶性心律失常和心源性死亡发生率比较,差异均无统计学意义(P>0.05)。结论 STEMI患者PCI术中使用血栓抽吸导管可显著减少无复流现象的发生,改善冠脉血流并减轻心肌损伤,这可能与增加血清ITLN-1的表达,进而减少心肌损伤并改善心功能相关。

Objective To investigate the effects of percutaneous coronary intervention(PCI) combined with thrombus aspiration and simple routine PCI on serum intelectin-1(ITLN-1), blood flow level, cardiac function and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods From January 2010 to June 2014, 549 STEMI patients undergoing PCI operation in the Department of Cardiology at Guilin People’s Hospital were enrolled. According to whether thrombus aspiration was performed, the patients were divided into thrombus aspiration combined with PCI group(combined group, 381 cases) and simple PCI group(168 cases). Indexes were compared between both groups, including postoperative blood flow TIMI classification, cardiac function at 1 week after operation(left ventricular ejection fraction [LVEF] and left ventricular end-diastolic diameter [LVDD]), postoperative peak values of serum creatine kinase(CK) and its isoenzyme(CK-MB), and ST-segment decline. Enzyme-linked immunoassay was used to detect the serum levels of ITLN-1 in the two groups of patients at admission, 24 h, 1 week, and 6 months after operation.Major adverse cardiovascular events were followed up for 6 months after operation. Results The serum levels of ITLN-1 at admission were respectively(141.5±87.2) ng/m L and(134.2±105.5) ng/m L in the combined group and the simple PCI group, without significant difference(P>0.05). The serum levels of ITLN-1 at 24 h after operation in the two groups were respectively(432.7 ± 151.4) ng/m L and(352.9 ± 135.3) ng/m L;and were respectively(338.9 ± 141.7) ng/m L and(297.5 ±155.7) ng/m L at 1 week after operation;differences between groups were statistically significant(P<0.05). However, the serum levels of ITLN-1 at 6 months after operation in the two groups were respectively(241.7±103.6) ng/m L and(234.8±98.6) ng/mL, and there was no significant difference between the two groups(P>0.05). The incidence of no-reflow or slow-flow in the combined group and the simple PCI group were respectively 3.9% and 10.1%, the CK level in the two groups were respectively(1 463.4±372.6) U/L and(1 835.1±280.3) U/L, and the CK-MB level in the two groups were respectively(163.5 ± 42.9) U/L and(217.2 ± 49.4) U/L;all differences between groups were statistically significant(P<0.05). The proportion of patients with ST-segment depression ≥50% in the combined group and the simple PCI group were respectively 86.1% and 61.3%, LVDD in the two groups were respectively(51.5±3.2) mm and(56.1±4.1) mm, and corresponding LVEF were respectively(57.2±3.5)% and(53.3±4.2)%;all differences between groups were statistically significant(P<0.05). After 6 months of follow-up, the incidence of heart failure in the combined group was 6.3%, which was significantly lower than 14.4% in the simple PCI group(P<0.05). There was no significant difference in the incidence of myocardial infarction, malignant arrhythmia and cardiac death between the two groups(P>0.05). Conclusion The use of thrombus aspiration in STEMI patients during PCI can significantly reduce the occurrence of no-reflow, improve the blood flow of coronary artery and attenuate myocardial injury, which may be related to elevate the expression of serum ITLN-1, and subsequently reduce myocardial damage and improve cardiac function.