尼可地尔联合曲美他嗪对AMI患者急诊PCI术后血清hs-CRP ESM-1 EMPs的影响

Effect of Nicorandil combined with Trimetazidine on Serum hs-CRP ESM-1 EMPs of Emergency Patients with AMI After PCI

目的:探讨尼可地尔联合曲美他嗪对急性心肌梗死患者急诊经皮冠状动脉介入(PCI)术后血清高敏C反应蛋白(hs-CRP)、内皮细胞特异性分子(ESM-1)、内皮细胞微粒(EMPs)的影响。方法:选择2015年10月至2017年10月我院接诊的92例急性心肌梗死患者进行研究,通过随机数表法分为观察组(n=46)和对照组(n=46),两组均行急诊PCI术,围术期给予常规治疗,对照组术后给予曲美他嗪治疗,观察组联合尼可地尔治疗,连续用药7d。比较两组心电图疗效、PCI术前及治疗后7d心功能、hs-CRP、ESM-1、EMPs的变化,并比较术后30d内不良心血管事件发生率。结果:治疗后7d,观察组临床疗效总有效率为93.48%(43/46),明显比对照组的73.91%(34/46)高(P<0.05);治疗后7d,两组心功能指标较PCI术前均显著改善(P<0.05),观察组左室舒张末期内径(LVDD)、左室收缩末期内径(LVDS)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)均明显低于对照组,左室射血分数(LVEF)明显比对照组高(P<0.05);治疗后7d,两组血清hs-CRP、ESM-1、EMPs较PCI术前均显著降低(P<0.05),且观察组血清hs-CRP、ESM-1、EMPs均明显低于对照组[(6.84±1.19)mg/L vs(8.94±1.46)mg/L,(0.89±0.11)μg/L vs(1.16±0.15)μg/L,(820.18±113.49)个/μL vs(1017.35±120.47)个/μL](P<0.05);两组术后30d内紧急冠状动脉血运重建、再发心肌梗死、脑卒中、脑卒中心源性死亡的总发生率分别为4.35%、13.04%,比较无显著差异(P>0.05)。结论:在急性心肌梗死患者急性PCI术后使用尼可地尔联合曲美他嗪效果显著,可有效改善术后心功能,短期预后良好,其内在机制可能可降低血清hs-CRP、ESM-1、EMPs的表达相关。

Objective:To study the effect of nicorandil combined with trimetazidine on serum high sensitive C reactive protein(hs-CRP),endothelial cell specific molecules-1(ESM-1),endothelial cell particles(EMPs)and in patients with acute myocardial infarction after emergency percutaneous coronary intervention(PCI).Methods:92 patients of acute myocardial infarction received therapy from October 2015 to October 2017 in our hospital were selected as research objects.According to random number table,those patients were divided into the observation group(n=46)and the control group(n=46),they were performed emergency PCI operation,and were given routine treatment during the perioperative period,the control group was treated with trimetazidine,while the observation group was combined with nicorandil,continuous use of 7 days.The electrocardiogram effect,the changes of cardiac function,hs-CRP,ESM-1 and EMPs before PCI and after treatment 7 days were compared between the two groups,and the incidence of adverse cardiovascular events in the after operation 30d was compared.Results:After 7 days treatment,the total effective rate in the observation group was 93.48%(43/46),which was significantly higher than that of the control group 73.91%(34/46)(P<0.05);after 7d treatment,the index of cardiac function in the two groups was significantly improved than that before PCI(P<0.05),and the left ventricular end diastolic diameter(LVDD),left ventricular end systolic diameter(LVDS),left ventricular end diastolic volume(LVEDV)and left ventricular end systolic volume(LVESV)in the observation group were significantly lower than those in the control group,the left ventricular ejection fraction(LVEF)was significantly higher than those in the control group(P<0.05);after treatment 7d,the serum hs-CRP,ESM-1,and EMPs in the two groups were significantly lower than those before the PCI(P<0.05),and the serum hs-CRP,ESM-1 and EMPs in the observation group were significantly lower than those in the control group[(6.84±1.19)mg/L vs(8.94±1.46)mg/L,(0.89±0.11)μg/L vs(1.16±0.15)μg/L,(820.18±113.49)number/μL vs(1017.35±120.47)number/μL](P<0.05);the total incidence of emergency coronary artery revascularization,recurrent myocardial infarction,stroke and cardiogenic death in the two groups was 4.35%and 13.04%,there was no significant difference(P>0.05).Conclusion:Nicorandil combined with trimetazidine is well for acute myocardial infarction after PCI,which can effectively improve the postoperative cardiac function,and the short-term prognosis is good,it's intrinsic mechanism may reduce the expression of serum hs-CRP,ESM-1 and EMPs.