伊伐布雷定对PCI术后患者心脏康复及vWF、MMP-9 及sTWEAK水平的影响

Influence of ivabradine on cardiac rehabilitation and levels of vWF,MMP-9 and sTWEAK in patients after PCI

目的:研究伊伐布雷定(IVB)对PCI术后患者心脏康复及血管性血友病因子(vWF)、基质金属蛋白酶(MMP)-9及可溶性肿瘤坏死因子样弱凋亡诱导因子(sTWEAK)水平的影响。方法:于我院行PCI术治疗的急性心肌梗死(AMI)患者138例被随机均分为常规治疗组(接受双联抗血小板、美托洛尔和基础药物治疗)和IVB组(在常规治疗组基础上接受IVB),治疗3个月。观察比较两组治疗前后6min步行距离(6MWD)、心率、LVEF、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、红细胞聚集指数(EAI)、全血黏度高切(BVH)、全血黏度低切(BVL)、纤维蛋白原(Fg)、血清vWF、MMP-9、sTWEAK水平,以及不良反应率。结果:与常规治疗组比较,治疗后IVB组6MWD[(367.16±34.68)m比(393.15±35.64)m]、LVEF[(45.61±5.06)%比(48.76±4.32)%]显著升高,心率[(77.26±7.74)次/min比(71.93±7.04)次/min]、LVEDV[(136.83±13.44)ml比(129.79±13.71)ml]、LVESV[(80.65±10.15)ml比(77.53±7.06)ml]、EAI[(2.26±0.27)比(2.14±0.24)]、BVH[(4.36±0.47)mPa·s比(4.15±0.44)mPa·s]、BVL[(10.80±1.09)mPa·s比(10.15±0.98)mPa·s]、Fg[(4.37±0.54)g/L比(4.15±0.38)g/L]、血清vWF[(95.08±9.53)mU/ml比(88.18±9.31)mU/ml]、MMP-9[(86.60±8.58)ng/L比(82.40±9.91)ng/L]、sTWEAK[(37.00±3.61)pg/ml比(34.74±3.58)pg/ml]水平显著降低,P<0.05或<0.01。两组不良反应率无显著差异,P=0.716。结论:伊伐布雷定可显著减慢PCI患者术后心率,改善血液流变学,提高心功能及运动能力,减轻内皮损伤,且不良反应少,值得推广。

Objective:To study influence of ivabradine(IVB)on cardiac rehabilitation(CR),levels of von Willebrand factor(vWF),matrix metalloproteinase(MMP)-9 and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)of patients after PCI.Methods:A total of 138 AMI patients undergoing PCI in our hospital were randomly and equally divided into routine treatment group(received dual antiplatelet,metoprolol and basic medication and IVB group(received IVB based on routine treatment group),both groups were treated for three months.The 6min walking distance(6MWD),heart rate,LVEF,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),erythrocyte aggregation index(EAI),whole blood viscosity at high shear rate(BVH),whole blood viscosity at low shear rate(BVL),levels of fibrinogen(Fg),serum vWF,MMP-9 and sTWEAK,and incidence rate of adverse reactions were observed and compared between two groups before and after treatment.Results:Compared with routine treatment group after treatment,there were significant rise in 6MWD[(367.16±34.68)m vs.(393.15±35.64)m]and LVEF[(45.61±5.06)%vs.(48.76±4.32)%],and significant reductions in heart rate[(77.26±7.74)beats/min vs.(71.93±7.04)beats/min],LVEDV[(136.83±13.44)ml vs.(129.79±13.71)ml],LVESV[(80.65±10.15)ml vs.(77.53±7.06)ml],EAI[(2.26±0.27)vs.(2.14±0.24)],BVH[(4.36±0.47)mPa·s vs.(4.15±0.44)mPa·s],BVL[(10.80±1.09)mPa·s vs.(10.15±0.98)mPa·s],levels of Fg[(4.37±0.54)g/L vs.(4.15±0.38)g/L],serum vWF[(95.08±9.53)mU/ml vs.(88.18±9.31)mU/ml],MMP-9[(86.60±8.58)ng/L vs.(82.40±9.91)ng/L]and sTWEAK[(37.00±3.61)pg/ml vs.(34.74±3.58)pg/ml]in IVB group,P<0.05 or<0.01.There was no significant difference in incidence rate of adverse reactions between two groups,P=0.716.Conclusion:Ivabradine can significantly reduce heart rate after PCI,improve hemorheology,cardiac function and exercise capacity,relieve endothelial injury with few adverse reactions,which is worth extending.