PCI术前给予替罗非班联合阿托伐他汀对急性心肌梗死患者外周血微RNA表达及血管内皮功能的影响

Effects of Tirofiban Combined with Atorvastatin before PCI on mi RNA Expression of Peripheral Blood and Vascular Endothelial Function in Acute Myocardial Infarction Patients

目的:探讨经皮冠状动脉介入术(PCI)术前给予替罗非班联合阿托伐他汀对急性心肌梗死患者外周血微RNA(mi RNA)表达及血管内皮功能的影响。方法:选取2015年1月-2016年6月我院收治的急性心肌梗死患者80例作为研究对象,按照随机数字表法分为对照组和观察组,各40例。两组患者均进行抗凝治疗;对照组患者于PCI术前30 min口服阿司匹林肠溶片300 mg+硫酸氢氯吡格雷片75 mg+阿托伐他汀钙片20 mg;观察组患者在对照组基础上给予注射用盐酸替罗非班首次剂量0.5 mg+0.9%氯化钠注射液100 m L,iv,之后改为0.4μg/(kg·min)泵注,30 min后改为0.1μg/(kg·min)泵注,持续时间为24 h。观察两组患者给药前和PCI术后外周血mi RNA(mi RNA-1、mi RNA-133a、mi RNA-208b、mi RNA-499)表达水平、肱动脉内径及血管内皮功能指标[血管性假血友病因子(v WF)、内皮素1(ET-1)、一氧化氮(NO)]水平,并记录不良反应发生情况。结果:治疗前,两组患者上述指标比较,差异均无统计学意义(P>0.05)。治疗后,两组患者mi RNA表达水平及v WF、ET-1水平均显著降低,且观察组显著低于对照组,差异均有统计学意义(P<0.05);两组患者肱动脉内径及NO水平均显著增加,且观察组显著大于或高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗过程中均未见明显的不良反应发生。结论:PCI术前给予替罗非班联合阿托伐他汀治疗急性心肌梗死,可降低患者mi RNA表达水平,增大肱动脉内径,对血管内皮功能具有保护作用,且安全性较高。

OBJECTIVE： To investigate the effects of tirofiban combined with atorvastation before PCI on the miRNA expres- sion of peripheral blood and vascular endothelial function in acute myocardial infarction （AMI） patients. METHODS ： A total of 80 patients with AMI selected from our hospital as reaserch objects during Jan. 2015-Jun. 2016 were divided into control group and observation group according to random number table, with 40 cases in each group. Both groups received anticoagulant therapy. Control group was given Aspirin enteric-coated tablets 300 mg＋Clopidogrel sulfate tablets 75 mg＋ Atorvastatin calcium tablets 20 mg orally 30 min before PCI. Observation group was additionally given Tirofiban hydrochloride for injection with initial dose of 0.5 mg±0.9% Sodium chloride injection 100 mL, iv, then adjusted to pump injection of 0.4 μg/（kg· min）, 30 min later adjusted to pump injection of 0.1 μg/（kg·min）, for consecutive 24 h. The levels of peripheral miRNA （miRNA-1, miRNA-133a, miR- NA-208b, miRNA-499）, the levels of brachial artery diameter and vascular endothelial function indexes （vWF, ET-1, NO） were observed in 2 groups before medication and after PCI, and the occurrence of ADR was recorded. RESULTS： Before treatment, there was no statistical significance in above indexes between 2 groups （P〉0.05）. After treatment, miRNA expression, the levels of vWF and ET-1 were decreased significantly in 2 groups, and observation group was significantly lower than control group, with statistical significance （P〈0.05）. The brachial artery diameter and NO levels of 2 groups were increased significantly, and observation group was significantly greater or higher than con- trol group, with statistical significance （P〈0.05）. No obvious ADR was found in 2 groups during treatment. CONCLU-SIONS： For AMI, tirofiban combined with atorvastation before PCI can reduce miRNA expression, increase brachial artery diame- ter and protect vascular endothelial function with good safety.