远隔缺血后适应对急性ST段抬高型心肌梗死患者的心肌保护作用

The effect of remote ischemic postconditioning induced on upper limb in patients with ST-segment elevation myocardial infarction

目的探讨肢体远隔缺血后适应(RIPost C)对急性ST段抬高型心肌梗死(STEMI)患者心肌缺血再灌注损伤的影响。方法选择STEMI并在心导管室行急诊直接经皮冠脉介入治疗(PPCI)患者80例。随机分为PPCI+RIPost C组(n=36)和PPCI组(n=44),两组均接受PPCI。PPCI+RIPost C组在球囊扩张3 min内针对上肢行RIPost C。受试者术前和术后0.5、8、24、48、72 h共抽取静脉血6次测定血清肌酸磷酸激酶同工酶(CK-MB)浓度。术后第7天应用心脏超声评估左心室射血分数(LVEF)。结果(1)PPCI+RIPost C组CK-MB峰值明显减低〔(280.60±45.83)ng/ml vs(352.21±65.42)ng/ml,P<0.01〕;PPCI+RIPost C组CK-MB曲线下面积中位数为717.25(364.63~921.98),PPCI组曲线下面积中位数为807.00(693.30~1 136.00),PPCI+RIPost C组较PPCI组CK-MB曲线下面积明显减低(P<0.05)。(2)PPCI+RIPost C组术后第7天LVEF显著高于PPCI组〔(54.50±9.73)%vs(48.14±7.04)%,P=0.01〕。结论针对上肢行RIPost C可以降低STEMI患者心肌坏死面积、提高患者LVEF,提示RIPost C对STEMI患者心肌缺血再灌注损伤有保护作用。

Objective To explore the effect of remote ischemic postconditioning（RIPostC） on ischemia-reperfusion injury（IRI） in patients with ST-segment elevation myocardial infarction（STEMI）. Methods 80 consecutive patients with STEMI were randomly to receive primary petcutaneous coronary intervention （PPCI） without RIPostC （ PPCI group, n = 36） or PPCI plus RIPostC （ PPCI＋ RIPostC group, n = 44）. RIPostC consisted of 4 cycles of 5 min/5 min ischemia/reperfusion by cuff in flation/deflation of the upper limb. Protocol was started in 3 minutes after the first balloon inflation during PPCI operation. Peripheral venous blood sample in all patients were collected before PPCI op- eration and 0.5,8,24,48,72 h after PPCI operation to detect creatine kinase（CK） -MB concentration in serum. The transthoracic echocardio- graphy was performed on all patients 7 days after operation to assess left ventricular ejection fraction（LVEF）. Results The peak CK-MB se- rum concentration in PPCI＋RIPostC was significantly lower compare to that of PPCI group[ （280.60±45.83）vs （352.21 ±65.42） ng/ml, P〈 0.01 ]. The median CK-MB area under the curve （AUC） over 72 h of PPCI＋RIPostC group was significantly less then PPCI group[ 717.25 （364.63± 921. 98） vs 807.00 （693.30 ± 1136.00）, P = 0.02）. LVEF assessed by transthoracic echocardiography in PPCI＋RIPostC group was significantly higher compare to that of PPCI group [ （54.50±9.73） % vs （48.14±7.04） %, P = 0.01 J. Conclusions RIPostC on upper limb could attenuate CK-MB release,improve the LYEF, may protect patients with STEMI from IRI.