不同Rho激酶活性ACS患者双联抗血小板聚集治疗后心脏结构和功能变化情况

Changes of cardiac structure and function in patients with acute coronary syndrome and different Rho kinase activities after treatment with dual anti-platelet aggregation

目的探讨双联抗血小板聚集治疗不同Rho激酶活性的急性冠状动脉综合征(ACS)患者心脏结构和功能变化情况。方法选取2015年3月~2016年2月于十堰市太和医院接受治疗的ACS患者150例,根据ACS患者的Rho激酶活性(界值为2.45,<2.45为低活性组,≥2.45为高活性组)的高低分为高活性组和低活性组,给予阿司匹林加氯吡格雷治疗。观察比较两组患者入院时以及给予阿司匹林加氯吡格雷治疗后3个月和12个月Rho激酶活性,并评估N-末端脑钠肽前体(NT-proBNP)变化情况以及与左心结构、功能,包括左房内径(LAD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)和心脏指数(CI),对比心血管不良事件发生率。结果高活性组入院时、治疗后3个月、12个月RHO激酶活性和NT-proBNP水平明显高于低活性组,差异有统计学意义(P均<0.05);两组入院时的LAD、LVEDD、LVEF和CI比较差异无统计学意义(P>0.05);治疗后3个月、12个月时,高活性组患者的LAD以及LVEDD明显高于低活性组,LVEF和CI低于低活性组,差异有统计学意义(P均<0.05);高活性组患者入院时、治疗后3个月、12个月高敏C反应蛋白水平高于低活性组患者(P<0.05)。高活性组患者治疗后不良心血管事件发生率为30.77%,高于低活性组6.94%,差异有统计学意义(P<0.05)。结论双联抗血小板聚集治疗Rho激酶活性较低的ACS患者效果优于活性较高的患者。

Objective To investigate the changes of cardiac structure and function in patients with acute coronary syndrome(ACS)and different Rho kinase activities after treatment with dual anti-platelet aggregation.Methods ACS patients(n=150)were chosen from Taihe Hospital of Shiyan City from Mar.2015to Feb.2016,and divided,according to Rho kinase activity(dividing value=2.45),into low-activity group(<2.45)and highactivity group(≥2.45).All groups were treated with aspirin and clopidogrel.The changes of Rho kinase activity were observed and compared in2groups at time points of hospitalization and aspirin-clopidogrel treatment for3months and12months.The changes of N-terminal pro-brain natriuretic peptide(NT-proBNP)and left cardiac structure and function,including left atrial diameter(LAD),left ventricular end-diastolic inner diameter(LVEDD),left ventricular ejection fraction(LVEF)and cardiac index(CI),were reviewed.The incidence of major adverse cardiovascular events(MACE)was compared.Results Rho kinase activity and NT-proBNP level were significantly higher in high-activity group than those in low-activity group at3time points(all P<0.05).The difference in LAD,LVEDD,LVEF and CI had no statistical significance between2groups at time of hospitalization(P>0.05).After treatment for3months and12months,LAD and LVEDD were significantly higher,and LVEF and CI were lower in high-activity group than those in low-activity group(all P<0.05).The level of high sensitivity C-reactive protein(hs-CRP)was higher in high-activity group than that in low-activity group at3time points(P<0.05).The incidence of MACE was30.77%in high-activity group and6.94%in low-activity group(P<0.05).Conclusion The curative effect of dual anti-platelet aggregation is higher in ACS patients with lower Rho kinase activity than that in those with higher Rho kinase activity.