左西孟旦对急性心肌梗死合并心力衰竭患者血清sST2水平的影响

Effect of levosimendan on serum soluble ST2 levels in acute myocardial infarction patients complicated with heart failure

目的:评估左西孟旦对直接经皮冠状动脉介入(PPCI)术后急性ST段抬高型心肌梗死(STEMI)合并心力衰竭患者血清可溶性ST2(sST2)水平的影响。方法:将87例PPCI术后前壁或广泛前壁STEMI合并心力衰竭(包括心原性休克)患者随机分为左西孟旦治疗组(研究组44例)和标准药物治疗组(对照组43例)。基线(d0)、第5天(d5)检测血清sST2水平,进行呼吸困难评分,并收集随访6个月主要不良心脏事件(MACE,包括心原性死亡与因心力衰竭再次住院)。结果:2组血清sST2基线水平比较差异无统计学意义。在d5时研究组血清sST2水平较对照组显著下降[(84. 5±28. 1) ng/mL vs (95. 7±22. 3) ng/mL,P <0. 05],呼吸困难评分较对照组显著改善[(3.3±0. 7)分vs (3. 0±0. 8)分,P <0. 05]。6个月临床随访时,研究组总体MACE发生率29. 5%,对照组37. 2%(P> 0. 05)。结论:左西孟旦可改善PPCI术后前壁或广泛前壁STEMI合并心力衰竭患者临床心功能,减低血清sST2水平。

Objective: To evaluate the effect of levosimendan on serum soluble ST2(sST2) levels in ST-segment elevation myocardial infarction(STEMI) patients complicated with heart failure after primary PCI(PPCI). Methods: A total of consequent 87 anterior or extensive anterior STEMI patients complicated with heart failure after PPCI were randomly divided into levosimendan group(study group,n = 44) and standard treatment group(control group,n = 43). Serum sST2 levels,dyspnea score and 6-month major adverse cardiac events(MACE,defined as cardiac death and rehospitalization for heart failure) were compared between two groups. Results: Baseline sST2 levels were not statistically different between two groups. On the day 5 after levosimendan treatment,sST2 levels were reduced significantly in the study group as compared with the control group [(84. 5 ± 28. 1) vs(95. 7 ± 22. 3) ng/mL,P < 0. 05]. There was a significantly larger improvement in dyspnea score in the study group than in the control group(3. 3 ± 0. 7 vs 3. 0 ± 0. 8,P < 0. 05). The total incidence of 6-month MACE showed no significant difference between the study group and the control group(29. 5% vs 37. 2%,P > 0. 05).Conclusions: Levosimendan could reduce serum sST2 levels and improve cardiac function in anterior or extensive anterior STEMI patients complicated with heart failure after PPCI.