吡格列酮预处理在冠心病合并2型糖尿病患者支架干预治疗中的心肌保护作用

Myocardial preservation of pioglitazone pretreatment in percutaneous coronary stents intervention on the CHD patients with 2-type DM

目的探讨吡格列酮预处理对冠状动脉支架治疗患者的心肌保护作用。方法将155例行择期冠状动脉支架术的2型糖尿病合并冠心病患者随机分为三组:吡格列酮高剂量组(30 mg)50例、吡格列酮低剂量组(15 mg)53例以及安慰剂的对照组52例。观察术后肌钙蛋白Ⅰ水平和4a型心肌梗死(支架术相关心肌梗死)发生率。结果吡格列酮适应组(高剂量组和低剂量组)术后16 h超敏肌钙蛋白Ⅰ中位数值显著低于对照组,4a型心肌梗死发生率显著低于对照组(34%或35.8%vs 56%,P<0.05)。结论吡格列酮预处理可降低择期PCI术后肌钙蛋白Ⅰ水平及4a型心肌梗死发生率。

Objective To assess the myocardial protection of piglitazone pretreatment in CHD patients with 2-type DM undergoing percutaneous coronary intervention ( PCI ). Methods The 155 participants undergoing PCI with normal baseline troponin values were analyzed. Patients with stable CAD who planned to undergo PCI were randomized in to three groups : high dose piglitazone group ( n=50 ) received piglitazone 30mg/h before procedure of PCI , low dose piglitazone group ( n=53 ) received piglitazone 15mg/h before procedure of PCI and control group ( n= 52 ). The primary outcomes were high sensitive cardiac troponin I ( hscTnI ) level and incidence of myocardial infarction ( MI 4a , defined as hscTnI>0.20ng/ml ) at 16 hours after PCI procedure. Results The median hscTnI at 16 hours after PCI was lower in the piglitazone pretreatment group compared with control group. Incidence of MI 4a was fewer in piglitazone pretreatment group compared with control group ( 34% or 35.8% vs 56%, P<0.05 ). Conclusion Piglitazone pretreatment can reduce post-PCI troponin I release and incidence of MI 4a in non- diabetic patients undergoing PCI.