不同途径应用替罗非班对急性ST段抬高型心肌梗死患者PCI术后炎症因子及内皮功能影响

Effects of Different Approaches of Tirofiban on Inflammatory Factors and Endothelial Function in after PCI in Patients with Acute St-segment Elevation Myocardial Infarction

目的:探讨不同途径应用替罗非班对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗(PCI)术后炎症因子及内皮功能的影响。方法:选择2018年1月-2019年3月本院心血管内科收治的拟行PCI术的急性ST段抬高型心肌梗死患者110例。按随机数字表法将患者分为对照组55例和观察组55例。对照组患者给予常规治疗+替罗非班外周静脉滴注,首次计量为10μg/kg,再以0.15μg/(kg·min)经微量注射泵持续静脉泵入24 h;观察组患者常规治疗+替罗非班经冠状动脉内注射用药,首次用药剂量为10μg/kg,再以0.15μg/(kg·min)经微量注射泵行持续静脉注射24 h。比较两组患者术后血清CyPA、hs-CRP、MMP-9、NO、VEGF、vWF水平及不良反应发生情况。结果:术前及术后1 d,两组血清CyPA、hs-CRP、MMP-9、NO、VEGF、vWF比较,差异均无统计学意义(P>0.05);与术前相比,术后1 d,两组血清CyPA、hs-CRP、MMP-9、VEGF、vWF均明显升高,血清NO浓度均明显下降,差异均有统计学意义(P<0.05)。术后1周,两组血清CyPA、hs-CRP、MMP-9、VEGF、vWF均较术后1 d明显下降,且观察组均明显低于对照组,差异均有统计学意义(P<0.05)。术后1周,两组血清NO均较术后1 d升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。对照组不良反应发生率为18.2%,观察组不良反应发生率为18.2%,两组患者治疗期间的不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在常规治疗的基础上,替罗非班经冠状动脉内注射用药与外周静脉用药相比,可明显降低急性心肌梗死患者PCI术后血清CyPA、hs-CRP、MMP-9、vWF、VEGF浓度,提高血清NO浓度,且未增加不良反应的发生。

Objective:To investigate the effects of Tirofiban on inflammatory factors and endothelial function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention(PCI).Method:A total of 110 patients with acute ST-segment elevation myocardial infarction who planned to undergo PCI were enrolled in the department of cardiology of our hospital from January 2018 to March 2019.According to random number table method,the patients were divided into control group 55 cases and observation group 55 cases.Control group was given conventional treatment+peripheral intravenous infusion of Tirofiban,the first dose was 10μg/kg,and then 0.15μg/(kg·min)through microinjection pump for 24 h continuous intravenous infusion.Observation group was treated with routine therapy+Tirofiban intra-coronary injection,the first dose was 10μg/kg,and then 0.15μg/(kg·min)through micro injection pump for continuous intravenous injection for 24 h.The levels of serum CyPA,hs-CRP,MMP-9,NO,VEGF,vWF and the incidence of adverse reactions were compared between two groups after operation.Result:Before and 1 d after surgery,there were no significant differences in serum CyPA,hs-CRP,MMP-9,NO,VEGF and VWF between the two groups(P>0.05).Compared with preoperation,1 d after operation,serum CyPA,hs-CRP,MMP-9,VEGF and vWF were significantly increased in both groups,while serum NO concentration were significantly decreased,the differences were statistically significant(P<0.05).1 week after operation,the serum CyPA,hs-CRP,MMP-9,VEGF,vWF in both groups were significantly decreased compared with 1 d after operation,and the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).1 week after operation,serum NO in both groups were higher than those on 1 d after operation,and the observation group was higher than the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the control group was 18.2%,and the incidence of adverse reactions in the observation group was 18.2%,there was no statistical significance in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion:On the basis of conventional treatment,Tirofiban intra-coronary injection compared with peripheral intravenous administration significantly reduced serum concentrations of CyPA,hs-CRP,MMP-9,vWF and VEGF in patients with acute myocardial infarction after PCI,increased serum NO concentration,and did not increase the occurrence of adverse reactions.