替罗非班冠状动脉给药对急性ST段抬高型心肌梗死患者介入治疗的临床疗效及外周血内PMPs水平的影响

Effects of Tirofiban Intracoronary Administration on the Interventional Therapy and Peripheral Blood PMPs Level in Patients with Acute ST-segment Elevation Myocardial Infarction

目的探讨替罗非班冠状动脉给药在急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)中的临床疗效及对外周血内血小板微粒(PMPs)水平的影响。方法选取2012年7月至2013年12月被确诊为急性STEMI并接受PCI治疗的患者124例,按照随机数字法将入组患者分为替罗非班组(62例)和对照组(62例),对照组予以常规PCI治疗;替罗非班组行PCI联合应用替罗非班治疗。比较两组患者术前的临床基础资料特征,术后病变血管心肌梗死溶栓治疗(TIMI)3级血流、校正的TIMI血流计数帧数(CTFC)、心肌灌注(TMPG)3级水平、术后90 min ST段回落程度>50%发生率;磷酸肌酸激酶同工酶(CK-MB)峰值及峰值时间和心肌肌钙蛋白I(cTnI)峰值。术后的左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和左心室收缩末期内径(LVESD);PCI手术前后两组患者外周血内PMPs水平变化;术后3个月内主要心脏不良事件(MACE)及出血事件发生率。结果术前两组患者基本临床资料比较,差异均无统计学意义(均p>0.05)。术后替罗非班组TIMI3级血流、TMP3级水平发生率和术后90 min ST段回落程度>50%发生率均高于对照组(P<0.05),校正TIMI帧数低于对照组(P<0.05);替罗非班组术后LVEF值明显高于对照组,LVEDD、LVESD值明显低于对照组(P<0.05);术前两组PMPs水平比较差异无统计学意义(P>0.05),术后两组PMPs水平均出现显著降低(P<0.05),替罗非班组PMPs水平显著低于对照组(P<0.05)。术后3个月内MACE发生率显著低于对照组(P<0.05),出血并发症发生率比较,差异无统计学意义(P>0.05)。结论在STEMI急诊PCI治疗患者中,替罗非班冠脉内给药可以明显改善术后心肌再灌注和近期心功能,降低外周血内PMPs水平和主要不良心血管事件发生率,并未增加出血事件发生率,临床应用安全有效。

Objective To investigate the effects of tirofiban intracoronary administration on the interventional therapy and peripheral blood PMPs level in patients with acute ST-segment elevation myocardial infarction. Methods Totally 124 STEMI patients undergoing PCI were selected and divided into control group （n=62） and tirofiban group （n=62）, the tirofiban group was received tirofiban combined PCI and the control group was treated with PCI. The basic clinical features before PCI, the thrombolysis in myocardial infarction （TIMI） flow grade 3, corrected TIMI flow counting frame count （CTFC）, myocardial perfusion （TMPG） grade 3, resolution of the sum of ST-segment elevation （sumSTR） in 90 minutes; peak-value and peak-time of phosphoric acid creatine kinase isoenzyme （CK-MB）, peak-value of cardiac troponin I （cTnl）, the left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDD） and left ventricular end-systolic diameter （LVESD） after PCI were observed and compared between the two groups. The peripheral blood PMPs levels before and after PCI were analyzed, as well as major adverse cardiovascular events （MACE） and incidence of bleeding within 3 months after PCI were observed and compared between the two groups. Results There was no statistical difference in basic clinical features between the two groups before PCI. The incidence rate of TMPG grade 3, TIMI grade 3 and sumSTR〉50% in the tirofiban group were significantly higher than those of the control group （P 〈0.05）, CTFC was significantly lower than that of the control group {P 〈0.05）. The level of LVEF of the tirofiban group was significantly higher than that of the control group after operation, while the LVESD and LVEDD were significantly lower than those of the control group after operation （P 〈0.05）. There was no significantly difference of PMPs levels before PCI between the two groups, the PMPs levels of the two group after operation were significantly lower than those of the preoperation, as well as the tirofiban group were significantly lower than that of the control group （P 〈0.05）. The incidence rate of MACE was significantly lower in tirofiban group than that in control group within 3 months postoperatively. There was no significantly difference of incidence rate of bleeding between the two groups （P〉0,05 ） . Conclusion In patients with STEMI, tirofiban intracoronary administration can significantly improve myocardial reperfusion , inhibit the PMPs level and incidence rate of MACE, and would not increase the incidence of bleeding complications, it is safe and effective in STEMI patients treated with PCI.