PCI术联合依达拉奉治疗ST段抬高型急性心肌梗死的疗效及其机制研究

Efficacy and mechanism of PCI combined with edaravone in the treatment of ST segment elevation acute myocardial infarction

目的分析经皮冠状动脉介入术(PCI)联合依达拉奉治疗ST段抬高型急性心肌梗死(ASTEMI)患者的疗效及其机制。方法选择2015年2月—2017年12月鄂东医疗集团黄石市中心医院心血管内科收治的ASTEMI患者94例为研究对象,采用随机数字表法分为PCI术联合依达拉奉治疗组(联合组)和PCI常规治疗组(PCI组),每组47例,比较2组PCI术后疗效、心功能改善情况、炎性指标、氧化应激及心功能相关血清学指标及并发症发生情况。结果 2组手术时间、植入支架数量、TIMI血流分级、CTFC、TMPG分级、ST段回落等PCI疗效指标比较差异均无统计学意义(P>0.05)。PCI术后14、30 d,联合组左室射血分数(LVEF)显著高于PCI组(t=9.402、13.526<0.01),左室舒张末期内径(LVEDD)低于PCI组(t=4.654、5.603,P<0.01);PCCI术后14 d联合组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、氧化低密度脂蛋白(ox-LDL)、C-反应蛋白(CRP)等炎性指标均显著低于PCI组(t=15.518、11.527、23.118、25.158、25.761,P<0.01);而丙二醛(MDA)、单核细胞趋化因子1(MCP-1)、肌酸激酶同工酶MB(CK-MB)均低于PCI组(t=18.930、4.394、2.975,P<0.01),心肌肌钙蛋白I(cTnI)高于PCI组(t=3.547,P<0.01)。2组术后7 d心肌再梗死率、心律失常发生率及术后4周病死率比较差异无统计学意义(P>0.05)。结论 PCI术联合依达拉奉治疗ASTEMI虽然不能直接改善PCI术的疗效指标,但可显著改善患者的心功能、炎性反应及氧化应激反应,且安全性良好,是一种有效的治疗方案。

Objective To investigate the efficacy and mechanism of percutaneous coronary intervention（PCI） combined with edaravone in the treatment of patients with ST segment elevation acute myocardial infarction（ASTEMI）. Methods Ninety-four cases of ASTEMI in Huangshi Central Hospital of Edong Healthcare Group from February 2015 to December 2017 were selected as the research subjects. The patients were randomly divided into PCI combined with edaravone treatment group（combined group） and PCI routine treatment group（PCI group）, 47 cases in each group, the curative effect, improvement of cardiac function, inflammatory index,oxidative stress and cardiac function related serological indexes in two groups after PCI were compared,and the occurrence of complications after treatment were analyzed. Results At 14 and 30 d after PCI, left ventricular ejection fraction（LVEF） in combined group was significantly higher than that in PCI group（t=9. 402, t =13. 526,P〈0. 05）,the left ventricular end diastolic diameter（ LVEDD） was lower than that in PCI group（t= 4. 654,t=5. 603, P 0. 05）; After PCI, the inflammatory indexes such as tumor necrosis factorα（TNF-α）, interleukin 6（IL-6）, interleukin 1β（ IL-1β）, oxidized low density lipoprotein（ox-LDL） and C reactive protein（ CRP） were significantly lower in the combined group than that in PCI group（t=15. 518,t=11.527,t= 23. 118,t= 25. 158,t= 25. 761,P 0. 01）; Malondialdehyde（MDA）, monocyte chemoattractant factor 1（ MCP-1） and creatine kinase isoenzyme MB（ CK-MB） were lower than those in PCI group（t= 18. 930, t =4. 394, t=2.975, P〈0.01）, cardiac troponin I（cTnI） was higher than that in PCI group（t =3.547, P〈0.05）; No severe complications such as abnormal liver function and abnormal serum uric acid were observed in the 2 groups. Conclusion PCI surgery combined with edaravone in the treatment of ASTEMI although not directly improve the efficacy index of PCI patients, however, the free radical scavenging function of edaravone can significantly improve the patients cardiac function, inflammatory response and oxidative stress response, and is a safe and effective.