尼可地尔联合阿托伐他汀对急性心肌梗死患者血清MMP-9、H-FABP、TLR4水平及预后的影响

Effects of nicorandil combined with atorvastatin on serum MMP-9,H-FABP,TLR4 levels and prognosis in patients with acute myocardial infarction

目的探讨尼可地尔联合阿托伐他汀对急性心肌梗死患者血清基质金属蛋白酶-9(MMP-9)、心型脂肪酸结合蛋白(h-FABP)、Toll样受体4(TLR4)水平及预后的影响。方法抽取2019年3月至2020年8月郑州大学附属郑州中心医院收治的114例急性心肌梗死患者,采用随机数字表法分为观察组和对照组,每组57例。对照组患者采用阿托伐他汀治疗,观察组在对照组基础上联合尼可地尔治疗。比较两组疗效及不良反应发生情况;对两组治疗前后血MMP-9、h-FABP、TLR4水平及心功能相关指标进行检测;并随访6个月,统计两组不良心脏事件发生率。结果观察组治疗有效率为96.49%,高于对照组的82.45%,P<0.05;两组治疗后MMP-9、H-FABP、TLR4水平均低于治疗前,且观察组低于对照组(P<0.05);两组患者心功能指标较治疗前均改善,且治疗后观察组左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)水平低于对照组,左室射血分数(LVEF)、心脏指数(CI)水平高于对照组(P<0.05);观察组治疗期间的不良反应发生率低于对照组(P<0.05);观察组不良心脏事件发生率为3.51%,低于对照组的15.78%,P<0.05。结论尼可地尔联合阿托伐他汀治疗可提高急性心肌梗死患者的临床疗效,降低血清MMP-9、H-FABP、TLR4水平,有效改善心功能及患者预后。

Objective To explore the effects of nicorandil combined with atorvastatin on serum matrix metalloproteinase-9(MMP-9),heart-type fatty acid binding protein(H-FABP),Toll-like receptor 4(TLR4)levels and prognosis in patients with acute myocardial infarction(AMI).Methods A total of 114 patients with AMI confirmed in Zhengzhou Central Hospital of Zhengzhou University were enrolled between March 2019 and August 2020.According to random number method,they were divided into observation group and control group,with 57 cases in each group.The control group was treated with atorvastatin,while observation group was treated with nicorandil on basis of control group.The curative effect and occurrence of adverse reactions between the two groups were compared.The expression levels of serum MMP-9,H-FABP and TLR4,and cardiac function related indexes in both groups were detected before and after treatment.After 6 months of follow-up,the incidence of adverse cardiac events in both groups was statistically analyzed.Results The effective rate of observation group was 96.49%,which was higher than 82.45%of control group,(P<0.05).After treatment,the levels of MMP-9,H-FABP and TLR4 in both groups were decreased,those in the observation group were lower than those in the control group(P<0.05).After treatment,the cardiac function indexes in both groups were improved.After treatment,the levels of left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)in observation group were lower than those in the control group,while the levels of left ventricular ejection fraction(LVEF)and cardiac index(CI)were higher than those in the control group(P<0.05).The incidence of adverse reactions during treatment in the observation group was lower than that in the control group(P<0.05),and the incidence of adverse cardiac events in the observation group was 3.51%,which was lower than15.78%in the control group(P<0.05).Conclusions Nicorandil combined with atorvastatin can significantly improve clinical curative effect on the AMI patients,reduce levels of serum MMP-9,H-FABP and TLR4,effectively improve cardiac function and prognosis.