尼可地尔对行PCI冠心病患者血管内皮功能及血清炎性反应的影响

Influence of nicorandil on vascular endothelial function and serum inflammatory reaction in CHD patients undergoing PCI

目的:研究尼可地尔对经皮冠状动脉介入(PCI)治疗的冠心病(CHD)患者血管内皮(VE)功能及血清炎性反应的影响。方法:选择在我院接受PCI治疗的CHD患者118例,随机分为常规治疗组(n=58)和尼可地尔组(60例,在常规治疗基础上采用尼可地尔治疗)。治疗6个月,观察两组治疗前后内皮功能、炎性因子、心肌损伤标志物水平变化以及主要不良心血管事件(MACE)发生情况。结果:治疗后,与常规治疗组比较,尼可地尔组肱动脉反应性充血内径[D1,(3.83±0.37)mm比(4.01±0.39)mm]、肱动脉血流介导的舒张功能[FMD,(14.33±1.42)%比(19.35±1.95)%],血清一氧化氮[NO,(70.72±7.82)μmol/L比(86.15±8.52)μmol/L]、白介素10[IL-10,(392.86±40.19)ng/ml比(472.75±48.62)ng/ml]水平显著升高,血清内皮素1[ET-1,(70.29±7.39)ng/L比(59.62±6.02)ng/L]、细胞间黏附分子[ICAM-1,(195.68±20.48)μg/L比(146.72±15.07)μg/L]、心肌肌钙蛋白I[cTnI,(0.471±0.071)ng/ml比(0.222±0.052)ng/ml]、肌酸激酶同工酶[CK-MB,(27.62±3.72)U/L比(14.79±1.52)U/L]、血小板平均体积[MPV,(10.26±1.06)fl比(9.75±0.95)fl]、高敏C反应蛋白[hsCRP,(5.36±0.63)mg/L比(3.08±0.27)mg/L]水平以及支架再狭窄率(20.69%比1.67%)、MACE总发生率(67.24%比10.00%)显著降低(P=0.001)。结论:尼可地尔可改善冠心病患者PCI术后内皮功能,降低炎性反应,保护心肌细胞,预后较好,值得临床应用。

Objective:To study influence of nicorandil on vascular endothelial function and serum inflammatory reaction in patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). Methods:A total of 118 CHD patients undergoing PCI in our hospital were randomly divided into routine treatment group (n=58) and nicorandil group (n=60, received nicorandil based on routine treatment), both groups were treated for six months. Endothelial function, levels of inflammatory factors and myocardial injury markers before and after treatment, and incidence of major adverse cardiovascular events (MACE) were observed and compared between two groups. Results:Compared with routine treatment group after treatment, there were significant rise in radial artery reactive hyperemia inner diameter [D1,(3.83±0.37) mm vs.(4.01±0.39) mm], flow-mediated dilation of brachial artery [FMD,(14.33±1.42)% vs.(19.35±1.95)%], serum levels of nitric oxide [NO,(70.72±7.82)μmol/L vs.(86.15±8.52)μmol/L]and interleukin-10 [IL-10,(392.86±40.19) ng/ml vs.(472.75±48.62) ng/ml], and significant reductions in serum levels of endothelin-1 [ET-1,(70.29±7.39) ng/L vs.(59.62±6.02) ng/L], intercellular adhesion molecule-1 [ICAM-1,(195.68±20.48)μg/L vs.(146.72±15.07)μg/L], cardiac troponin I [cTnI,(0.471±0.071) ng/ml vs.(0.222±0.052) ng/ml], creatine kinase isoenzyme MB [CK-MB,(27.62±3.72) U/L vs.(14.79±1.52) U/L], mean platelet volume [MPV,(10.26±1.06) fl vs.(9.75±0.95) fl], high sensitive C reactive protein [hsCRP,(5.36±0.63) mg/L vs.(3.08±0.27) mg/L], in-stent restenosis rate (20.69% vs. 1.67%) and incidence rate of MACE (67.24% vs. 10.00%) in nicorandil group, P <0.05 or <0.01. Conclusion:Nicorandil can improve postoperative endothelial function, reduce inflammatory reaction, protect myocardial cells with good prognosis in CHD patients undergoing PCI, which is worth extending.