丹参川芎嗪注射液对急性ST段抬高型心肌梗死经皮冠状动脉介入术后患者的心肌保护作用机制

Effect of Danshen Chuanxiong Injection on myocardial protection and its mechanism in patients with acute ST segment elevation myocardial infarction after PCI

目的探讨丹参川芎嗪注射液对急性ST段抬高型心肌梗死经皮冠状动脉介入术(PCI)术后患者心肌保护作用及其机制。方法选择2017年6月至2019年6月期间南京大学医学院附属鼓楼医院收治的急性ST段抬高型心肌梗死PCI术后患者122例,依据随机数字表法分为联合组与对照组各61例。2组患者均行PCI术治疗,术前口服阿司匹林肠溶片和硫酸氢氯吡格雷片。对照组术后给予常规治疗,联合组在对照组基础上给予丹参川芎嗪注射液治疗。2组疗程均为14 d。比较2组治疗前后心功能变化[左心室射血反射(LVEF)、左室舒张末期内径(LVEDD)],血浆N末端脑钠肽前体(NT-proBNP)和心肌酶指标[肌酸激酶同工酶(CK-MB)和肌钙蛋白T(cTnT)]变化,炎症因子[血管内皮生长因子(VEGF)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]变化,血管内皮功能和氧化应激变化,及不良反应发生情况。结果联合组治疗后LVEF[(56.47±5.13)%]高于对照组[(50.38±3.27)%],而LVEDD[(45.32±1.98)mm]低于对照组[(48.82±2.15)mm],差异均有统计学意义(P<0.05)。联合组治疗后血浆NT-proBNP[(497.93±64.52)ng/mL]和CK-MB[(12.31±2.76)ng/mL]低于对照组[(789.83±120.24)ng/mL、(19.83±4.35)ng/mL],而cTnT[(0.38±0.09)ng/mL]高于对照组[(0.25±0.07)ng/mL],差异均有统计学意义(P<0.05)。联合组治疗后血浆VEGF[(118.98±15.46)mg/L]、IL-6[(8.74±1.42)pg/ml]和TNF-α[(10.27±1.58)pg/mL]低于对照组[(184.35±21.09)mg/L、(11.27±2.09)pg/mL、(15.42±2.39)pg/mL],差异均有统计学意义(P<0.05)。联合组治疗后血浆ET-1[(43.56±6.87)μmol/L]低于对照组[(62.65±8.97)μmol/L],SOD[(93.24±7.58)U/mL]高于对照组[(78.93±4.87)U/mL],MDA[(6.84±1.39)μmol/L]低于对照组[(8.97±1.54)μmol/L],差异均有统计学意义(P<0.05)。2组治疗期间均未发生明显不良反应。结论丹参川芎嗪注射液对急性ST段抬高型心肌梗死PCI术后具有良好心肌保护作用,其机制可能与减轻炎症反应及改善血管内皮功能和氧化应激有关。

Objective To investigate the myocardial protective effect and mechanism of Danshen Chuanxiong Injection on patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention(PCI).Methods From June 2017 to June 2019,122 patients with acute ST segment elevation myocardial infarction after PCI were randomly divided into combined group(61 cases)and control group(61 cases).Patients in both groups were treated with PCI,and aspirin enteric coated tablets and clopidogrel bisulfate tablets were taken before operation.The patients in the combined group were treated with Danshen Chuanxiong Injection on the basis of the control group.The course of treatment in both groups was 14 days.The changes of cardiac function(LVEF,LVEDd),N-terminal pro brain natriuretic peptide(NT proBNP),myocardial enzyme index(CK-MB,cTnT),inflammatory factors(VEGF,IL-6 and TNF-α),the changes in endothelial function,oxidative stress,and adverse reactions were compared before and after treatment.Results After treatment,the combined group LVEF(56.47%±5.13%)was higher than that in the control group(50.38%±3.27%),while LVEDd(45.32%±1.98%)mm was lower than that in the control group(48.82±2.15)mm(P<0.05).After treatment,the combined group NT proBNP(497.93±64.52)ng/mL and CK-MB(12.31±2.76)ng/mL were lower than those in the control group(789.83±120.24)ng/mL and(19.83±4.35)ng/mL,while cTnT(0.38±0.09)ng/mL was higher than those in the control group(0.25±0.07)ng/mL(P<0.05).After treatment,the combined group levels of VEGF(118.98±15.46)mg/L,IL-6(8.74±1.42)pg/mL and TNF-α(10.27±1.58)pg/mL were lower than those in the control group(184.35±21.09)mg/L,(11.27±2.09)pg/mL and(15.42±2.39)pg/mL(P<0.05).After treatment,the combined group level of ET-1(43.56±6.87)μmol/L was lower than that in the control group(62.65±8.97)(P<0.05).After treatment,the combined group plasma SOD(93.24±7.58)U/mL was higher than that in the control group(78.93±4.87)U/mL,while the MDA(6.84±1.39)μmol/L was lower than that in the control group(8.97±1.54)μmol/L(P<0.05).No significant adverse reactions occurred in two groups.Conclusion Danshen Chuanxiong Injection has a good myocardial protective effect on acute ST segment elevation myocardial infarction after PCI,and its mechanism may be related to the reduction of inflammatory response,improvement of vascular endothelial function and oxidative stress,and can improve myocardial enzymes,reduce NT proBNP,and have no obvious adverse reactions,so it is safe to use.