伴IGT的STEMI患者行PCI前后血清MIP-1α的变化及阿卡波糖的干预价值

Serum MIP- 1α level before and after PCI in patients with STEMI and IGT and acarbose＇ intervention value

目的探讨伴糖耐量降低（IGT）的ST段抬高型急性心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）前后血清巨噬细胞炎症蛋白1α（MIP—1α）的变化及阿卡波糖对其干预价值。方法选择拟行PCI的STEMI患者160例，设为A组。依据是否合并IGT，再将分入A，组（伴IGT者）和A2组（不伴IGT者），随机将A，组等分人A1a组和A1b组；选取健康志愿者30例，设为B组。A组行标准PCI术，A1a组自PCI后另予阿卡波糖治疗，连续6个月。A组于PCI前（T0）、PCI后24h（T1）、PCI后6个月（T2）；B组于体检当日，采用双抗体夹心酶联免疫吸附试验（ELISA）测定血清MIP—1α水平。A1组、A2组均于T0时间点，A1组另于T2时间点，行超声心动图检查了解左心室结构和功能。结果A组中，伴IGT的STEMI患者构成比为71．25％。T0时间点，A组血清MIP-1α水平显著高于B组（t=7．37，P〈0．01），A1组高于A2组（t=4．63，P〈0．05）；T1时间点，A组血清MIP—1α水平均升高（t-3．65—4．77，P〈0．05），A1组高于A2组水平（t=5．21，P〈0．05）；T2时间点，A组血清MIP—1α均显著降低（t=6．13—7．62，P〈0．01），且A1a组血清MIP—1α低于A1b组（t=4．06，P〈0．05）。T2时点，A1a组、A1组的LVD、LVMI减小，LVEF增大（t=3．67—6．21，P〈0．05或P〈0．01），A1b组的LVMI减小，LVEF增大（tLVMI=3．53，tLVEF=3．85，P〈0．05）；且A1a组LVD、LVMI数值低于A1b组，LVEF数值高于A1b组（t=3．40～4．12，P〈0．05）。结论伴IGT的STEMI患者血清MIP-1α水平显著高于健康人群，行PCI术后呈一过性升高，其后逐渐降低。对伴IGT的STEMI患者予以阿卡波糖干预治疗，能进一步降低血清MIP-1α水平，缓解机体炎症反应程度，改善左心室结构和功能，这对于伴IGT的STEMI患者临床诊疗具有一定的借鉴意义和参考价值。

Objective To explore the serum MIP - 1α level before and after PCI in patients with STEMI and IGT and acarbose＇ intervention value. Methods 160 STEMI patients undergoing PCI were selected as group A1 and were divided into group A1 （with IGT） and group A2 （without IGT）, and patients in group A1 were randomly divided into group A1a and group A1b, and 30 healthy volunteers were selected as group B. Patients in group A were all given standard PCI surgery, and patients in group A1a were given treatment of acarbose in addition for 6 months. On timepoint before PCI （TO ）, 24 h after PCI （T1）, 6 months after PCI （T2 ） in group A, and on the day of medical examination in group B, their serum MIP - 1 α level were detected by ELISA. On timepoint of To in group A1 and group A2, they were all given echoeardiography to understand left ventricular structure and function. Results The proportion of patients with STEMI and IGT was 71.25%. At T0, serum MIP - 1α level in group A was significantly higher than that in group B （ t = 7.37, P 〈 0.01 ）, also group Al＇s serum MIP - 1α level was higher than that in group A2 （t = 4.63, P 〈 0.05 ）. At Tt , serum MIP - 1α level were all increased in group A （t =3.65 -4.77, P 〈 0.05）, and group At＇s level was higher than that in group A2 （t = 5.21 ,P 〈 0. 05）. At T2, serum MIP - 1α level were all decreased in group A1a, A1b, A1, A2 and A （t = 6.13 - 7.62, P 〈 0. 01 ）, and group A1＇s level was lower than that in group A2 （t =4.06, P 〈 0.05）. At T2, LVD and LVMI were all decreased, and LVEF were increased in group A1a and group A1 （t = 3.67 - 6.21, P 〈0.05 or P 〈 0.01 ）, LVMI was decreased and LVEF was increased in group A1b （tLVMI -= 3.53, tLVEF = 3. 85, P 〈 0.05）, yet LVD and LVMI in group A1a were all lower than that in group A1b, and LVEF was higher than that in group Alb （t = 3.40 - 4.12, P 〈 0.05）. Conclusion Serum MIP - 1α level in patients with STEM1 and IGT are significantly higher than those in healthy person, showing a transient increase after PCI and a gradually decrease thereafter. Intervention with acarbose therapy on patients with STEMI and IGT, can further reduce serum MIP - 1αlevel, relieve inflammatory reaction, and improve the structure and function of left ventricle, so it has certain reference value for its clinical diagnosis and treatment.