环孢素A联合缺血适应对于急性ST段抬高型心肌梗死患者再灌注损伤的影响

Effect of cyclosporine A combined with ischemic adaptation on reperfusion injury in patients with acute ST-segment elevation myocardial infarction

目的观察环孢素A联合缺血适应对于急性ST段抬高型心肌梗死(STEMI)患者再灌注损伤的影响。方法将接受急诊PCI的121例STEMI患者随机分为环孢素A+缺血适应组40例、缺血适应组41例和PCI组40例。比较3组术前及术后(4,8,12,16,24,30,36,42,48,72,96,120,144,168,192,216,240h)血清超敏肌钙蛋白T(hs-TnT)水平,计算出hs-TnT峰值及曲线下面积;测定术后1dC反应蛋白(hs-CRP)、术后1周脑钠肽前体(NT-proBNP)、术后1周6min步行距离和术后1d、1周、1个月、3个月、6个月左室射血分数(LVEF)、左室舒张末期内径(LVDd),并统计术后6个月内心血管事件(MACE)发生率。结果环孢素A+缺血适应组和缺血适应组的hs-TnT峰值、hs-TnT曲线下面积均明显低于PCI组(P均<0.05),且环孢素A+缺血适应组的hs-TnT峰值、hs-TnT曲线下面积均明显低于缺血适应组(P均<0.05);环孢素A+缺血适应组和缺血适应组急诊PCI术后1周NT-proBNP水平均明显低于PCI组(P均<0.05),术后1周6min步行距离明显长于PCI组(P<0.05),但环孢素A+缺血适应组和缺血适应组急诊PCI术后1周NT-proBNP水平和6min步行距离比较差异无统计学意义(P>0.05);环孢素A+缺血适应组急诊PCI术后1周、1个月、3个月、6个月LVEF和缺血适应组术后1周、1个月LVEF均明显高于PCI组(P均<0.05),环孢素A+缺血适应组和缺血适应组急诊PCI术后1周、1个月、3个月、6个月LVEF比较差异均无统计学意义(P均>0.05);环孢素A+缺血适应组急诊PCI术后6个月内MACE发生率明显低于PCI组(P<0.05),但环孢素A+缺血适应和缺血适应组以及缺血适应+和PCI组术后6个月内MACE发生率比较差异均无统计学意义(P均>0.05)。结论缺血适应能明显缩小STEMI行急诊PCI患者的心肌梗死面积,改善心功能及患者预后;环孢素A联合缺血适应处理对减轻心肌损伤效果明显优于单独的缺血适应处理,二者存在协同效应。

Objective It is to observe the effect of cyclosporine A combined with ischemic adaptation on reperfusion injury in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods 121 patients with STEMI who underwent emergency PCI were randomly divided into three groups: cyclosporine A+ischemic adaptation group (combination group)(40 cases), ischemic adaptation group (41 cases) and PCI group (40 cases). The levels of preoperative and postoperative (4, 8, 12, 16, 24, 30, 36, 42, 48, 72, 96, 120, 144, 168, 192, 216, 240 h) serum hypersensitive troponin T (hs-TnT) were compared among the three groups, the hs-TnT peak and the area under the curve were calculated;the C-reactive protein (hs-CRP) at 1 day after surgery, the brain natriuretic peptide precursor (NT-proBNP) at 1 week after surgery were measured, 6-minute walking distance at 1 week after surgery, and left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd) at 1 d, 1 week, 1 month, 3 months, and 6 months after surgery were detected, and the incidence of major adverse cardiac events(MACE) within 6 months after surgery (MACE) was counted. Results The hs-TnT peak and hs-TnT curve erea were significantly lower in the combination group and the ischemic group than that in the PCI group ( P <0.05), and these indexes in the combination group were significantly lower than that in the ischemic adaptation group ( P <0.05). The level of NT-ProBNP at 1 week after surgery was significantly lower and the walking distance of 6 minutes after 1 week was significantly longer in the combination group and the ischemic group than that of the PCI group ( P <0.05), but there was no significant difference in the level and the 6-minute walking distance between combination group and ischemic group( P >0.05). The LVEF at 1 week, 1 month, 3 months, and 6 months after emergency PCI in the combination group and that at 1 week and 1 month after operation in the ischemic group were significantly higher than PCI group ( P <0.05), there was no significant difference in LVEF at 1 week, 1 month, 3 months, 6 after emergency PCI between the two groups ( P >0.05). The incidence of MACE in the cyclosporine A+ischemic group was significantly lower than that in the PCI group ( P <0.05). There was no significant difference in the incidence of MACE between the three groups within 6 months after operation ( P >0.05). Conclusion Ischemia adaptation can significantly reduce myocardial infarct size in patients with emergency PCI for STEMI, improve cardiac function and prognosis. The effect of cyclosporine A combined with ischemic adaptation is better than that of ischemia alone.