远隔缺血预处理对稳定性冠心病老年患者生活质量和预后的影响

Effect of Remote Ischemic Preconditioning on Life Quality and Prognosis in Elderly Patients with Stable Coronary Artery Disease

目的探讨远隔缺血预处理(RIPC)对稳定性冠心病老年患者生活质量和预后的影响,进一步阐述其临床应用价值。方法本研究为前瞻性队列研究。选取2016年1月至2017年12月在某院心内科住院的稳定性冠心病老年患者共215例作为研究对象,均行择期经皮冠状动脉介入治疗(PCI),采用随机数字表法分为RIPC组(105例)和对照组(110例)。RIPC组患者在入院后第2、3和4天的每天上、下午各行一轮无创上肢缺血预适应,第5天行PCI术;对照组在入院后第5天直接行PCI术。比较两组患者的心肌酶、心功能、西雅图量表评分及随访12个月不良心血管事件(MACE)。结果两组患者的年龄、男性比例、高血压、糖尿病等基线资料相似(均P>0.05)。此外,RIPC组PCI术后24小时的高敏心肌肌钙蛋白T的峰值显著低于对照组(P=0.01),但两组的左心室射血分数和NYHA心功能分级无显著差别(均P>0.05)。随访12个月,RIPC组患者的生活质量西雅图量表评分均较对照组有显著改善(均P<0.05);RIPC组有11例MACE事件,对照组有15例,两组间差异无统计学意义(P>0.05)。多因素Logistic回归分析发现基线左心室射血分数和NYHA心功能分级是影响术后12个月MACE的独立危险因素。结论远隔缺血预处理能减轻冠状动脉再灌注损伤程度,改善生活质量,但对中期心功能和MACE无显著影响,仍需要更多大型研究验证RIPC对老年稳定性冠心病患者的预后影响。

Objective To explore the effect of remote ischemic nreconditioninz （RIPC） on life quality and prognosis in elderly patients with stable coronary artery disease, and try to evaluate its clinical value. Methods A total of 215 elderly patients with stable coronary artery disease hospitalized in Beijing Anzhen Hospital from January 2016 to December 2017 were recruited, and were randomly divided into the RIPC group （n=105） and control group （n=110）. All patients were treated by PCI. In the second day after admission, the RIPC arOUD conducted RIPC twice every dav for 3 davs. and then the PCI was performed on the 5th dav. The control aTOUD nerformed PCI directlv on the 5th dav after admission without RIPC. The cardiac biomarkers, cardiac function, life quality and all cardiac events within 12 months follow-up were compared between groups. Results Basic characteristics, including age, male ratio, hypertension, diabetes, were similar between groups （all P〈0.05）. The peak level of hs-cTnT in 24h postoperatively was markedly lower （P=0.01） in RIPC group than control group. Moreover, RIPC was associated with markedly improved life quality compared with the control group （both P〈0.05）. However. rates of MACE were comnarable between groups （P〉0.05）. Multi-Logistic regression analysis showed that the baseline left ventricular eiection fraction and NYHA classification were indenendent risk factors for MACE. Conclusions The RIPC can reduce the reperfusion injury and improve the life quality for elderly patients with stable coronary artery disease. However, more large studies are warranted to confirm these findings.