阿替普酶联合瑞舒伐他汀治疗急性心肌梗死的疗效及对血GDF-15、GMP-140、sCD40L水平的影响

Therapeutic effect of alteplase combined rosuvastatin on acute myocardial infarction and its influence on levels of serum GDF-15,plasma GMP-140 and sCD40L

目的:探究阿替普酶联合瑞舒伐他汀治疗急性心肌梗死(AMI)患者的疗效及对血清生长分化因子(GDF)-15、血浆血小板颗粒膜蛋白(GMP)-140、可溶性T细胞CD40配体(sCD40L)水平的影响。方法: 2015~2017年我市急救站接诊的AMI患者138例被随机分为瑞舒伐他汀组(n=68)与联合治疗组(n=70,在瑞舒伐他汀组基础上接受阿替普酶治疗),均治疗3周。对比两组患者临床疗效,血清GDF-15、血浆GMP-140、sCD40L水平,心功能。结果:联合治疗组治疗总有效率显著高于瑞舒伐他汀组(95.71%比76.47%, P =0.001);与治疗前相比,治疗后两组的血清GDF-15、血浆GMP-140及sCD40L水平均显著下降,而左室射血分数(LVEF)及肱动脉内皮依赖性舒张功能(FMD)则显著上升( P <0.05或<0.01)。治疗后,与瑞舒伐他汀组比较,联合治疗组的血清GDF-15[(874.24±146.65)ng/L比(761.37±95.86)ng/L]、血浆GMP-140 [(31.86±6.17)ng/ml比(22.73±5.12) ng/ml]及sCD40L[(52.38±9.55)mg/L比(48.27±10.02) mg/L]水平下降更显著,而LVEF[(50.43±4.78)%比(55.28±5.02)%]及FMD[(7.26±1.07)%比(8.84±1.23)%]则升高更显著, P <0.05或<0.01。两组不良反应率无显著差异( P =0.561)。结论:阿替普酶联合瑞舒伐他汀治疗急性心肌梗死患者可显著提高疗效,降低血清GDF-15、血浆GMP-140及sCD40L水平,并可提高心功能与内皮功能,值得推广。

Objective: To explore therapeutic effect of alteplase combined rosuvastatin on patients with acute myocardial infarction (AMI) and its influence on levels of serum growth differentiation factor (GDF)-15,plasma thrombolytic granule membrane protein (GMP)-140 and soluble T cell CD40 ligand (sCD40L). Methods: A total of 138 AMI patients treated in emergency station of our city from 2015 to 2017 were randomly divided into rosuvastatin group (n=68) and combined treatment group (n=70,received alteplase based on rosuvastatin group),both groups were treated for three weeks. Therapeutic effects were compared between two groups. Results: Total effective rate of combined treatment group was significantly higher than that of rosuvastatin group (95.71% vs. 76.47%, P =0.001). Compared with before treatment,there were significant reductions in levels of serum GDF-15,plasma GMP-140 and sCD40L,and significant rise in LVEF and fore brachial artery endothelium dependent diastolic-systolic function (FMD) in two groups after treatment, P <0.05 or <0.01. Compared with rosuvastatin group after treatment,there were significant reductions in levels of serum GDF-15[(874.24±146.65)ng/L vs.(761.37±95.86)ng/L],plasma GMP-140 [(31.86±6.17)ng/ml vs.(22.73±5.12) ng/ml] and sCD40L[(52.38±9.55)mg/L vs.(48.27±10.02) mg/L],and significant rise in LVEF[(50.43±4.78)% vs.(55.28±5.02)%] and FMD[(7.26±1.07)% vs.(8.84±1.23)%] in combined treatment group, P <0.05 or <0.01. There was no significant difference in incidence rate of adverse reactions between two groups, P =0.561. Conclusion: Alteplase combined rosuvastatin can significantly improve therapeutic effect,reduce levels of serum GDF-15,plasma GMP-140 and sCD40L,and improve cardiac function and endothelial function in AMI patients,which is worth extending.