经皮冠状动脉介入术联合前列地尔治疗急性心肌梗死作用机制临床研究

Clinical Study on the Mechanism of Percutaneous Coronary Intervention Combined with Alprostadil in the Treatment of Acute Myocardial Infarction

目的探讨经皮冠状动脉介入术(PCI)联合冠状动脉内注射前列地尔对急性心肌梗死(AMI)患者心功能,外周血miRNA-208a、miRNA-208b水平及TIMI血流分级的影响。方法选择医院2015年8月至2016年10月收治的AMI患者90例,随机分为对照组和观察组,各45例。对照组患者行PCI手术,观察组患者在此基础上注射前列地尔。结果观察组患者治疗后TIMI血流分级显著优于对照组(P <0.05);与术后24 h比较,术后7 d两组患者N-末端脑钠肽前体(NT-proBNP)含量明显减少,左心室射血分数(LVEF)明显升高,且观察组上述指标明显优于对照组;与术前比较,两组术后7 d血清miRNA-208a和miRNA-208b表达水平显著下降(P <0.05),且观察组显著低于对照组(P <0.05);两组患者不良反应发生率无显著差异(P> 0.05)。结论 PCI联合冠状动脉内注射前列地尔可用于AMI的治疗,其机制与改善血液循环和心功能,提高TIMI血流分级及降低患者外周血miRNA-208a、miRNA-208b水平有关。

Objective To investigate the effect of the percutaneous coronary intervention(PCI)combined with intracoronary injection of alprostadil on the cardiac function,the levels of miRNA-208a and miRNA-208b in peripheral blood and the TIMI grade in patients with acute myocardial infarction(AMI).Methods Totally 90 patients with AMI admitted to our hospital from August 2015 to October 2016 were selected and randomly divided into the control group and the observation group,45 cases in each group.The patients in the control group were treated with PCI,on this basis,the patients in the observation group were injected with alprostadil.Results After treatment,the blood vessel grade of TIMI in the observation group was significantly higher than that in the control group(P<0.05).Compared with 24 h after operation,the content of N-terminal pro-brain natriuretic peptide(NT-proBNP)was significantly decreased,while the left ventricular ejection fraction(LVEF)was significantly increased on the 7th d after operation in the two groups,and the above indexes in the observation group were significantly better than those in the control group(P<0.05).Compared with that before operation,the expression levels of serum miRNA-208a and miRNA-208b in the two groups were significantly decreased on the 7th day after operation(P<0.05),and those in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between the two groups(P >0.05).Conclusion PCI combined with intracoronary injection of alprostadil can be used in the treatment of AMI.Its mechanism is related to improving blood circulation and cardiac function,improving the blood vessel grade of TIMI and reducing the levels of miRNA-208a and miRNA-208b in peripheral blood.