早期应用替罗非班对STEMI合并糖尿病患者PCI治疗的临床疗效及心肌保护作用分析

Clinical efficacy and myocardial protection effect of early administration of tirofiban in patients with STEMI complicated with diabetes after percutaneous coronary intervention

目的研究早期应用替罗非班对急性ST段抬高心肌梗死(STEMI)合并2型糖尿病(T2DM)患者行经皮冠状动脉介入(PCI)的疗效及对心肌的保护作用。方法选取2016年10月~2018年5月于阜阳市人民医院心内科收治并确诊的STEMI合并T2DM需行PCI治疗的118例患者为研究对象,按随机数字表将研究对象随机分为对照组(n=59)和观察组(n=59)。对照组PCI术前通过冠脉推注替罗非班,观察组进入急诊室即通过外周血管静脉推注替罗非班。比较两组患者心肌梗死溶栓(TIMI)分级、术后24 h ST段完全回落率、心肌灌注情况;术前、术后3 h、6 h、24 h、72 h测定心肌损伤标志物磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnⅠ)、肌红蛋白(MYO)和心脏型脂肪酸结合蛋白(H-FABP);记录术后30 d出血事件及主要不良心脏事件(MACE)。结果两组患者ST段完全回落率(37.3%vs.44.1%)、出血率(10.2%vs.15.3%)和MACE发生率(16.9%vs.11.9%)相比较,差异均无统计学意义(P均>0.05);与对照组相比,观察组术后TIMI分级较优,心肌灌注速度、心肌血流量也明显较高,差异均具有统计学意义(P均<0.05);观察组术后3 h、6 h、24 h、72 h心肌损伤标志物CK、CK-MB、cTnⅠ、MYO、H-FABP均较对照组低,差异均具有统计学意义(P均<0.05)。结论STEMI合并T2DM患者PCI术前早期使用替罗非班安全有效,且可加强心肌保护作用。

Objective To observe the efficacy and myocardial protection of early administration of tirofiban on patients with acute ST-elevation myocardial infarction(STEMI)complicated with type 2 diabetes mellitus(T2DM)undergoing percutaneous coronary intervention(PCI).Methods From Oct.2016 to Jun.2018,118 cases enrolled in department of cardiology of Fuyang people's Hospital were randomly divided into control group(59 cases)and study group(59 cases).The control group received tirofiban just prior to PCI,the study group received tirofiban before entering the emergency room and PCI.The thrombolysis in myocardial infarction(TIMI)grade,complete STsegment resolution 24h after operation,the reperfusion status was compared.Myocardial injury markers such as creatine kinase(CK),creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),myoglobin(MYO)and heart type-fatty acid binding protein(H-FABP)were measured.the incidence of major adverse cardiovascular events(MACE)and hemorrhagic events during 30 days were recorded.Results There was no statistically significant difference in the ST-segment complete regression rate(37.3%vs.44.1%),bleeding rate(10.2%vs.15.3%),and MACE incidence(16.9%vs.11.9%)between the two groups(P>0.05).Compared with the control group,the TIMI grade was better in the observation group,the myocardial perfusion rate and myocardial blood flow were also significantly higher,and the differences were statistically significant(P<0.05).The myocardial injury markers CK,CK-MB,cTnI,MYO and H-FABP were lower in the observation group than in the control group at 3 h,6 h,24 h and 72 h after operation,and the difference was statistically significant(P<0.05).Conclusion Early administration of tirofiban before emergency PCI is efficient and safe for patients with acute STEMI complicated with T2DM treated by PCI,and could enhance the myocardial protection.