抗氧化治疗联合二级预防对老年陈旧性心肌梗死氧化应激及预后的影响

Antioxidation therapy combined with secondary prevention for elderly patients with previous myocardial infarction

目的探讨抗氧化治疗联合冠心病二级预防对老年陈旧性心肌梗死患者转归的影响。方法于2015年1月至2017年1月纳入老年陈旧性心肌梗死患者220例,采用信封随机法分为观察组和对照组,各110例。对照组接受冠心病二级预防干预;观察组在此基础上联用抗氧化剂普罗布考。于干预前、干预后6个月时检测外周血超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平,检测超声心动图并评估心功能,并在随访中观察两组患者不良反应及再入院情况。结果干预前,两组外周血SOD、MDA、GSH-Px水平、左心室射血分数(LVEF)、心排血量(CO)、心排血指数(CI)、肺动脉平均压、心功能分级比较,差异均无统计学意义(均P>0.05)。干预后6个月时,两组SOD、GSH-Px均显著增加(均P<0.01),MDA均显著下降(均P<0.01),干预后观察组SOD、GSH-Px水平显著高于对照组(均P<0.01),MDA水平显著低于对照组(P<0.05)。干预后6个月时,观察组LVEF、CO、CI显著高于对照组,肺动脉平均压显著低于对照组,上述差异均有统计学意义(均P<0.01);观察组心功能分级显著优于对照组,差异有统计学意义(P<0.05)。观察组12个月内再入院率显著低于对照组,差异有统计学意义(P<0.05)。结论抗氧化治疗联合冠心病二级预防可降低老年陈旧性心肌梗死氧化应激水平,有利于改善患者心功能及预后。

Objective To assess the efficacy of antioxidation therapy combined with secondary prevention for elderly patients with history of myocardial infarction. Methods From January 2015 to January 2017, 220 elderly patients with previous myocardial infarction were randomly divided into study group and control group with 110 cases in each group. The control group received secondary prevention of coronary heart disease, while the study group received antioxidant probucol in addition. The serum superoxide dismutase(SOD), malondialdehyde(MDA) and glutathione peroxidase(GSH-Px) levels were detected, the echocardiography were performed and cardiac function were evaluated before treatment and 6 months after treatment. The adverse events and rate of rehospitalization in 2 groups was observed during the follow-up. Results Before treatment, there were no significant differences in serum SOD, MDA and GSH-Px level, left ventricular ejection fraction(LVEF), cardiac output(CO), cardiac index(CI), pulmonary artery mean pressure and cardiac function between the two groups(all P >0.05). At 3 and 6 months after treatment, SOD and GSH-Px levels in both group were increased significantly(all P<0.01), and MDA level decreased significantly(all P<0.01). The SOD and GSH-Px levels in the study group was significantly higher than those in the control group(all P<0.01). The MDA level in the study group was significantly lower than that in the control group(P<0.05). At 6 months after treatment, the LVEF, CO and CI in the study group were significantly higher than those in the control group;the pulmonary artery mean pressure in the study group was significantly lower than that in the control group(all P<0.01). The grade of cardiac function in the study group was significantly better than that in the control group(P<0.05). The rate of rehospitalization within 12 months in the study group was significantly lower than that in the control group(P<0.05). Conclusion Antioxidation therapy combined with secondary prevention for coronary heart disease can improve heart function and prognosis for elderly patients with previous myocardial infarction.