还原型谷胱甘肽辅助瑞替普酶提高急性ST段抬高型心肌梗死疗效分析

Therapeutic effects of reduced glutathione combined with reteplase on acute ST segment elevation myocardial infarction

目的探讨还原型谷胱甘肽(GSH)协同瑞替普酶(r PA)治疗急性ST段抬高型心肌梗死(STEMI)的疗效。方法收集收治的STEMI被试对象,将其随机分为r PA治疗组和r PA联合GSH治疗组。检测2组被试对象治疗前及治疗后24 h的血清肌钙蛋白I(c Tn I)、肌钙蛋白T(c Tn T)和肌酸激酶同工酶(CK-MB)浓度及左室射血分数(LVEF)等指标。采用独立样本t检验分析治疗前后c Tn I、c Tn T及CK-MB的变化,采用χ~2检验比较治疗前后的LVEF。结果 2组被试对象溶栓后3 h、6 h及12 h的血管再通率差异无统计学意义(P>0.05)。与治疗前相比,r PA组和r PA联合GSH组在治疗后24 h的c Tn I、c Tn T、CK-MB和LVEF均明显升高(P<0.05)。与r PA组治疗后24 h的结果比较,r PA联合GSH组c Tn I、c Tn T及CK-MB的升高幅度小,LVEF的升高幅度大(P<0.05)。对患者溶栓后1个月内主要心血管事件(MACE)的发生率进行随访,发现r PA联合GSH治疗组MACE发生率明显低于r PA治疗组(P<0.05)。结论还原型谷胱甘肽联合瑞替普酶治疗STEMI能更好地保护心肌细胞的结构和功能,具有较高的临床应用价值。

Objective To observe the therapeutic effects of reduced glutathione（ GSH） combined with reteplase（ r PA） on acute ST segment elevation myocardial infarction（ STEMI）. Methods The patients with STEMI who were treated in our Hospital were enrolled as research subjects,and these patients were randomly divided into r PA treatment group and r PA combined with GSH treatment group（ combination treatment group）. The serum levels of cardiac troponin I（ c Tn I）,cardiac troponin T（ c Tn T）,creatine kinase isoenzyme（ CK-MB） and left ventricular ejection fraction（ LVEF） before and 24 h after treatment were detected and compared between the two groups. Moreover the changes of serum levels of c Tn I,c Tn T and CK MB before and after treatment were analyzed by means of independent simple T test,and the LVEF levels before and after treatment were observed and analyzed by means of chi-square test. Results There was no significant difference in vascular recanalization rate between the two groups at 3 h,6 h and 12 h after thrombolysis（ P〈 0. 05）. The serum levels of c Tn I,c Tn T,CK-MB and LVEF at 24 h after treatment were significantly increased in both groups,as compared with those before treatment（ P〈 0. 05）. As compared with that in r PA treatment group at 24 h after treatment,the increase degree of c Tn I,c Tn T and CK MB in combination treatment group was smaller,and the increase degree of LVEF was larger（ P〈 0. 05）. Moreover the incidence rate of major cardiovascular events（ MACE） at one month after thrombolysis in combination treatment group was significantly lower than that in r PA treatment group（ P〈 0. 05）. Conclusion Reduced GSH combined with r PA in treatment of STEMI can protect the structure and function of myocardial cells better,which has higher clinical application value.