前列地尔对直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者心肌灌注的影响

Effect of alprostadil on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨前列地尔对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者心肌灌注的影响。方法选取2017年11月至2018年4月在本院就诊的符合条件的160例STEMI患者作为研究对象,随机分为前列地尔组80例和对照组80例,前列地尔组在对照组常规治疗的基础上给予前列地尔治疗。比较2组患者心肌灌注指标如心肌梗死溶栓试验(TIMI)血流分级、校正的TIMI帧数(CTFC)、心肌显影密度分级(MBG)及PCI术后2 h ST段回落率(STR)≥50%及术后无复流情况;检测入院时及PCI术后7天患者血清中炎症指标如肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及高敏C反应蛋白(hs-CRP);收集患者术后3天及出院后3个月心脏彩色超声指标左心室舒张末期内径(LVEDD)和左心室射血分数(LVEF);随访出院后3个月内发生的主要不良心脏事件(MACE)。结果 (1)2组基线资料一致,具有可比性。(2)前列地尔组PCI术后TIMI 3级、MBG 3级比例及2 h STR≥50%的发生率均高于对照组(P<0.05),而术后无复流发生率和CTFC帧数均低于对照组(P<0.05)。(3)2组入院时血清TNF-α、IL-6和hs-CRP含量均无显著差异(P>0.05);前列地尔组术后7天血清TNF-α、IL-6和hs-CRP含量均低于对照组(P<0.01)。(4)随访3个月,前列地尔组LVEDD小于对照组、LVEF大于对照组(P<0.05);前列地尔组总的MACE及心力衰竭发生率均小于对照组(P<0.05)。结论行直接PCI治疗的STEMI患者应用前列地尔能够有效减弱炎症反应,恢复心肌再灌注,减少心肌微循环障碍的的发生,同时可以改善患者心功能及预后。

Aim To investigate the effect of alprostadil on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods 160 STEMI patients who met the criteria from November 2017 to April 2018 in our hospital were selected as the study subjects. They were randomly divided into alprostadil group (80 cases) and control group (80 cases). Alprostadil group was treated with alprostadil on the basis of routine treatment in the control group. The indexes of myocardial reperfusion, such as thrombolysis in myocardial infarction (TIMI) blood flow grade, corrected TIMI frame count (CTFC), myocardial blush grade (MBG), ST-segment resolution (STR) more than or equal to 50% within 2 hours after PCI and no-reflow after PCI, were compared between the two groups. The levels of inflammatory indexes such as tumor necrosis factor α(TNF-α), interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) were detected in serum at admission and 7 days after PCI. Left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) of colour sonography were measured at 3 days after PCI and 3 months after discharge. Major adverse cardiac events (MACE) within 3 months after discharge were followed up. Results (1)The baseline data of the two groups were consistent and comparable.(2)The incidences of TIMI grade 3, MBG grade 3 after PCI and STR more than or equal to 50% within 2 hours after PCI in alprostadil group were higher than those in control group (P<0.05), while the incidence of no-reflow and the number of CTFC frames were lower than those in control group (P<0.05).(3)There were no significant differences in serum TNF-α, IL-6 and hs-CRP levels between the two groups on admission (P>0.05). The serum levels of TNF-α, IL-6 and hs-CRP in alprostadil group were lower than those in control group on the 7th days after PCI (P<0.01).(4)After 3 months follow-up, the LVEDD of the alprostadil group was lower than that of the control group and the LVEF was higher than that of the control group (P<0.05). The incidences of total MACE and heart failure in the alprostadil group were lower than those in the control group (P<0.05). Conclusion The application of alprostadil in STEMI patients undergoing primary PCI can effectively reduce inflammation, restore myocardial reperfusion, reduce the occurrence of myocardial microcirculation disorders, and improve cardiac function and prognosis.