急性心肌梗死患者介入治疗前经缺血后处理对心肾功能的影响

Effects of ischemic postconditioning on heart-kidney functions in patients with acute myocardial infarction before percutaneous coronary intervention

目的探索缺血后处理对于行介入治疗术(PCI)的急性心肌梗死患者心肾功能的作用。方法选取2014年1月至2016年7月因急性心肌梗死入院的患者255例。按照是否接受缺血后处理(IPC)将患者分为2组,干预组124例,在介入治疗术前行IPC,对照组131例,直接行介入治疗。治疗结束后一段时间多次观察记录患者再灌注心律失常发生率、血清肌酸激酶同工酶(CK-MB)值、肾小球滤过率(e GFR)、超敏C-反应蛋白(CRP)水平等,并于所有患者出院后对其进行为期12个月的随访,记录不良预后事件发生的例数。比较2组患者术后再灌注心律失常发生率、急性肾功能损伤发生率和e GFR的差异;重复测量方差分析比较2组患者CK-MB值、CRP水平的差异。绘制Kaplan-Meier生存曲线反映2组患者术后随访时的生存情况,log-rank检验比较其结果。结果术后6 h干预组和对照组的CK-MB水平均达峰值,干预组的CK-MB水平[(239. 88±50. 37) U/L]显著低于对照组[(275. 64±57. 83) U/L],差异有统计学意义(P <0. 05)。干预组Δe GFR为(9. 42±18. 23) ml·min-1·1. 73m-2,对照组的Δe GFR为(16. 20±23. 65) ml·min-1·1. 73m-2,干预组显著低于对照组,差异有统计学意义(P <0. 05)。干预组术后12个月的生存率高于对照组,差异有统计学意义(P <0. 05)。结论 IPC对于行PCI术的急性心肌梗死患者心肾功能具有短期和长期的保护作用。

Objective To explore the effects of ischemic postconditioning on cardiorenal functions in patients with acute myocardial infarction （AMI） before primary percutaneous coronary intervention. Methods A total of 255 patients with AMI, who were admitted and treated in our hospital from January 2014 to July 2016, were divided into IPC intervention group （ n =124） and control group （ n =131）.The patients in control group were treated by PCI, while the patients in IPC intervention group were treated by ischemic postconditioning before PCI. After treatment, the incidence of reperfusion arrhythmia, CKMB value, eGFR and CRP were observed and recorded for many times. Moreover, all subjects were followed up for 12 months to record the incidence of adverse events. In addition, the difference of the incidence of reperfusion arrhythmia after surgery, acute injury incidence of renal function and eGFR of the patients between the two groups were compared. And variance was repeatedly measured to compare the difference in CKMB and CRP between the two groups.Kaplan-Meier survival curves were used to compare the survival status between the two groups. Log rank was used to test and compare the experiment results. Results After treatment, the CK MB levels reached peak at 6h in both groups,and the CK MB levels [（239.88±50.37）U/L]and eGFR[（9.42±18.23）ml·min ^-1 ·1.73m ^-2 ] in intervention group were significantly lower than those in control group （ P 〈0.05）. In addition, the 12-month survival rate after operation in intervention group was significantly higher than that in control group （ P 〈0.05）. Conclusion Ischemic postconditioning can has short-term and long-term protective effects on cardiorenal function of AMI patients undergoing PCI.