罗红霉素在AMI患者介入治疗后再灌注损伤的作用

Effect of roxithromycin on MIRI in AMI patients undergoing PCI

目的探讨罗红霉素在急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)术后心肌再灌注损伤(MIRI)中的保护作用。方法选择2012年6月至2013年8月我院心内科行PCI治疗的AMI患者80例,80例患者随机分为对照组和观察组,每组40例。使用酶联免疫吸附双抗体夹心法(ELISA)检测肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6。流式细胞仪检测中性粒细胞凋亡。结果两组术前TNF-α和IL-6表达水平比较差异无统计学意义(P>0.05),术后两组TNF-α和IL-6表达水平均出现显著升高(P<0.05),24 h时达到峰值(P<0.05),以后逐渐下降(P<0.05),但术后12、24、48、72 h,观察组TNF-α和IL-6表达水平均显著低于对照组(P<0.05)。PCI术前对照组和观察组的中性粒细胞凋亡率分别为12.6%±3.4%和11.8%±3.7%,两组比较差异无统计学意义(P>0.05)。术后对照组和观察组的中性粒细胞凋亡率分别为28.3%±7.9%和47.5%±11.2%,均显著高于术前(P<0.01);且观察组中性粒细胞凋亡率显著低于对照组(P<0.05)。对照组左室射血分数和心肌梗死面积分别为42.53%±4.36%和21.03%±4.02%,观察组为48.91%±4.82%和16.55%±3.27%,两组间上述指标比较差异有统计学意义(P<0.05)。结论罗红霉素可以抑制PCI术后的炎症反应,对预防PCI术后MIRI有一定的临床价值。

Objective To explore the effect of roxithromycin on myocardial ischemia-reperfusion injury（MIRI） in acute myocardial infarction（AMI） patients undergoing percutaneous coronary intervention（ PCI）. Methods80 AMI patients undergoing PCI were divided into control group（n = 40） and observation group（n = 40）. The protein expression of TNF-α and IL-6 were detected by ELISA analysis. The apoptosis of neutrophils was detected by flow cytometry. Results Before PCI,there was no significant difference in protein expression of TNF-α and IL-6 between the two groups（P〈0. 05）. After PCI,the expression of TNF-α and IL-6 of the two groups increased（P〈0. 05）,and the expression reached peak value at 24 h after PCI（P〈0. 05）,then it gradually decreased（P〉0. 05）. The expression of TNF-α and IL-6 was significantly lower in observation group than that in control group at 12,24,48,72 h after PCI（P〈0.05）. Before PCI,the apoptotic rates of neutrophils of control group and observation group were 12.6% ±3.4%and 11. 8% ± 3. 7%,no significant difference was observed between the two groups（P〉0. 05）. After PCI,the apoptotic rates of neutrophils were 28. 3% ± 7. 9% and 47. 5% ± 11. 2% in control group and observation group,there was significant difference before and after PCI（P〈0. 01）,and the apoptotic rate of neutrophils in observation group was higher than that of control group（ P〈0. 01）. The left ventricular ejection fraction and infarct size were 42. 53% ±4. 36% and 21. 03% ± 4. 02% in control group,and 48. 91% ± 4. 82% and 16. 55% ± 3. 27% in observation group,there were significant differences between the two groups（P〈0. 05）. Conclusion Roxithromycin can inhibit the inflammatory response after PCI,which contributes to the prevention of MIRI.