缺血后处理对急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗疗效的研究

Effects of ischemic post-conditioning on patients with acute ST-segment elevation myocardial infarction undergoing primary PCI

目的探讨缺血后处理对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的疗效。方法收集STEMI患者,分为直接行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗组和缺血后处理再行PCI治疗组,比较两组患者基线资料,以及不同时间点肌钙蛋白浓度、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度和PCI治疗后第7天心脏功能情况。结果(1)两组基线资料比较,差异无统计学意义(P>0.05),均以中年男性人群为主,50%以上同时合并吸烟、糖尿病和高血压等危险因素;从发病到就诊平均时间约5 h;主要以前壁心肌梗死为主,两组均超过60%。(2)两组PCI治疗前基线肌钙蛋白-I浓度均升高,但组间比较差异无统计学意义(P>0.05);PCI治疗后第48天时,两组肌钙蛋白-I浓度峰值比较,差异有统计学意义[对照组vs.缺血后处理组:(5.8±1.4)ng/mL vs.(4.3±1.1)ng/mL,P<0.001];PCI治疗后第7天时,缺血后处理组肌钙蛋白-I浓度下降较对照组明显,差异有统计学意义[对照组vs.缺血后处理组:(3.2±0.7)ng/mL vs.(2.0±0.8)ng/mL,P<0.001]。(3)PCI治疗后第7天时,与对照组相比,缺血后处理组左心室容积较小,左心室射血分数较高,差异有统计学意义(P<0.05)。与此同时,PCI治疗后第7天时,缺血后处理组血浆NT-proBNP浓度明显低于对照组[对照组vs.缺血后处理组:(617±70)pg/mL vs.(504±66)pg/mL,P<0.001]。结论 STEMI患者缺血后处理再行PCI治疗有利于减少围术期心肌细胞坏死和凋亡,起到改善患者心功能的作用。

Objectives To evaluate the effects of ischemic post-conditioning on patients with acute ST-segment eleva?tion myocardial infarction(STEMI).Methods Patients with STEMI were enrolled and divided into primary percutane?ous coronary intervention(PCI)group and ischemic post-conditioning plus PCI group.Baseline characteristics,serum concentrations of cardiac troponin-I(cTn-I),N-terminal pro-brain natriuretic peptide(NT-proBNP)at different time points were compared and left ventricular heart function was evaluated on the seventh day post-PCI.Results(1)No sig?nificant differences between the two groups were observed in baseline characteristics,and males were predominant in both groups,and more than50%of patients had risk factors including cigarette smoking,diabetes and hypertension;and duration from symptom on-set to get admission was nearly5hours and more than60%of patients were diagnosed as ante?rior wall of myocardial infarction(P>0.05).(2)Serum concentrations of cTn-I were increased in both groups but without significant differences between the two groups(P>0.05).Serum concentrations of cTn-I were at peak in both groups at48hours post-PCI,with significant difference between the two groups[control group vs.ischemic post-conditioning group:(5.8±1.4)ng/mL vs.(4.3±1.1)ng/mL,P<0.001].On the seventh day after PCI,serum concentration of cTn-I was reduced more significantly in the post-conditioning group[control group vs.ischemic post-conditioning group:(3.2±0.7)ng/mL vs.(2.0±0.8)ng/mL,P<0.001].(3)On the seventh day post-PCI,left ventricular volume was significantly smaller in ischemic post-conditioning group when compared with control group,while left ventricular ejection fraction was higher(P<0.05).Similarly,serum concentration of NT-proBNP in ischemic post-conditioning group was also significantly lower compared with control group[control group vs.ischemic post-conditioning group:(617±70)pg/mL vs.(504±66)pg/mL,P<0.001].Conclusions Our study reveals that in patients with STEMI,it is beneficial to reduce cardiomyocytes necro?sis and apoptosis and to improve cardiac function with performing ischemic post-conditioning before PCI.