急性ST段抬高型心肌梗死患者PCI术前应用尼可地尔对炎症反应和心肌损伤的影响

Effects of Nicorandil on Inflammatory Response and Myocardial Injury in Acute ST-segment Elevated Myocardial Infarction Patients Before PCI

目的研究急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前应用尼可地尔对炎症反应和心肌损伤影响。方法将100例接受PCI的STEMI患者按照随机数字表法分为常规治疗组48例和尼可地尔组52例。常规治疗组给予急性心肌梗死常规治疗,尼可地尔组在此基础上于PCI术前30min口服尼可地尔10mg。比较两组患者PCI术前、术后12h及24h中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、心肌肌钙蛋白I(cardiac troponin I,cTnI)和肌酸激酶同工酶(creatine kinase MB,CK-MB)的水平,并对PCI术后24h NLR、hs-CRP、cTnI和CK-MB进行相关性分析。结果PCI术后12h和24h尼可地尔组NLR、hs-CRP、cTnI、CK-MB均低于常规治疗组,除了术后12h两组患者NLR差异无统计学意义(P>0.05),其余各项指标在术后12h和24h差异均有统计学意义(P<0.05)。PCI术后24hNLR与hs-CRP、cTnI、CK-MB呈正相关关系(r=0.955、0.948、0.949,P均<0.001);PCI术后24hhs-CRP与cTnI、CK-MB呈正相关关系(r=0.941、0.944,P均<0.001)。结论 STEMI患者PCI术前口服尼可地尔可以有效抑制炎症反应,从而减少因PCI导致的心肌损伤。

Objective To observe the effects of nicorandil on inflammatory response and myocardial injury in acute ST-segment elevated myocardial infarction（STEMI）patients before percutaneous coronary intervention（PCI）.Methods One hundred STEMI patients underwent PCI were divided into the routine group（48 cases）and the nicorandil group（52 cases）by random number table.All patients were given conventional treatment for acute myocardial infarction,while the nicorandil group was given an additional 10 mg nicorandil 30 min before PCI.The neutrophils-to-lymphocyte ratio（NLR）,levels of high-sensitivity C-reactive protein（hs-CRP）,cardiac troponin I（cTnI）and creatine kinase MB（CKMB）were compared between two groups before PCI at 12-and 24-hour postoperative period.The correlation analysis of NLR,hs-CRP,cTnI and CK-MB at 24 hours after PCI was performed.Results The levels of NLR,hs-CRP,cTnI and CK-MB in the nicorandil group were lower than those in the routine group at 12-and 24-hour postoperatively.There were signifantly differences in above indexes except NLR at 12 hours after PCI（P〈0.05）.NLR in the first 24 hours after PCI was positively correlated to the levels of hs-CRP,cTNI and CK-MB（r=0.955,0.948,0.949,P〈0.001）.The hs-CRP level at 24 hours after PCI was positively correlated to the levels of cTnI and CK-MB（r=0.941,0.944,P〈0.001）.Conclusion STEMI patients take nicorandil by orally before PCI can effectively inhibit the inflammatory respone,and thus reduce myocardial injury.