丹参滴丸联合强化降脂治疗对急性心肌梗死PCI术后再梗死的预防作用研究

Study on Preventive Effect of Re-Infarction of Danshen Dripping Pill Combined with Intensive Lipid Lowering Therapy in Acute Myocardial Infarction Patients after PCI

目的:探讨丹参滴丸联合强化降脂治疗对急性心肌梗死PCI术后再梗死的预防作用。方法:选取医院自2014年4月—2014年11月确诊的急性ST段抬高型心肌梗死行PCI术患者104例,根据随机数字表法进行分组,对照组52例予以术后予以常规降脂治疗,控制原发病等常规治疗,研究组52例在常规治疗上予以丹参滴丸(10丸/次,tid)联合强化降脂(阿托伐他汀钙片80 mg/d,qd)治疗,3个月为1疗程。用药前、介入后24 h及介入后7 d采血测定血清细胞因子、心肌损伤标志物及血管内皮功能指标,对比两组间心肌微循环灌注状况,进行2年的随访,观察并记录心血管事件。结果:经单因素方差分析,与用药前比较,两组用药不同时间点血清细胞因子、心肌损伤及血管内皮功能指标存在差异(P<0.05);与对照组比较,研究组介入后24 h、介入后7 d时血清CRP、TNF-α、IFN-γ、IL-6含量较低,血清CK-MB、c Tn I、BNP含量较低,血清ET、s ICAM-1含量较低,NO含量较高(P<0.05);研究组用药后心肌微循环灌注改善程度更高(P<0.05);随访2年期间无病例脱落现象,两组间心血管事件对比,无差异(P>0.05)。结论:丹参滴丸联合强化降脂治疗对急性心肌梗死PCI术后心肌保护作用较强,抑制手术导致的炎症反应及血管内皮损伤,改善心肌微循环灌注。

Objective ： To investigate the preventive effect of re - infarction of Danshen Dripping Pill combined with intensive lipid lowering therapy in acute myocardial infarction patients after PCI. Methods： A total of 104 cases with acute ST segment elevation myocardial infarction under PCI in this study from April 2014 to December 2014 from our hospital were selected and randomly divided into two groups. Fifty - two patients in control group received conventional lipid - lowering therapy, control of primary disease treatment. Fifty - two cases in the experiment group received more with Danshcn Pill（ 10 pills, rid） combined with intensive lipid- lowering （Atorvastatin Calcium Tablets 80 mg/d, qd） and two groups were treated for 3 months. Levels of blood serum cytokines, myocardial damage markers and endothelial function in two groups were compared to evaluate myocardial microcirculation perfusion status at 24 h and 7 d after the intervention, and followed up for 2 years to observe cardiovascular events. Results ： Compared with before treatment, levels of serum cytokiues and myocardial injury and vascular endothelial function indexes in two groups at different time points had difference by the single factor analysis of variance（P 〈 0. 05 ）. Compared with the control group, levels of serum CRP, TNF - α, IFN - γ and IL - 6 contents in the experiment group were lower after the intervention of 24 h and 7 days, levels of serum CK - MB, eTnI and BNP were lower. Levels of serum ET and sICAM - 1 content were lower and levels of NO content were higher （ P 〈 0. 05 ）. And compared with the control group, improvement degree of myocardial microcirculation perfusion in the experiment was higher after treatment （ P 〈 0.05 ） and there was no case shedding phenomenon during the follow - up period of 2 years and there was no difference between the two groups （ P 〉 0. 05 ）. Conclusion ： Danshen Dripping Pill combined with intensive lipid lowering therapy in acute myocardial infarction patients after PCI has strong protective effect. It can inhibit the inflammatory reaction and vascular endothelial injury induced by surgery and improve myocardial microcirculation perfusion.